In modern society, mobility has become increasingly important. A growing number of kilometres are travelled, many of which are driven by car. In the Netherlands, for example, the number of kilometres travelled has increased from 144.2 milliard in 1985 to 190.9 milliard in 2003. A large proportion of this increment can be attributed to transportation by car (from 107.0 to 146.1 milliard)1. Moreover, there is a significant shift in the age distribution in western societies towards higher age. Additionally, older persons also show an increased mobility in general, and an increased number of kilometres driven by car in particular. Simultaneous to the increasing mobility, the incidence of both type 1 and type 2 diabetes is mounting throughout the world. It is hypothesised that the former increases due to infectious, nutritional or environmental changes, whereas the latter is most probably related to changes in obesity and lifestyle. After the DCCT and the UKPDS, which showed that diabetic complications are reduced with tight glucose control, management of diabetic patients is progressively aiming at near-normoglycaemia. Consequently, the rate of hypoglycaemia has markedly increased. This almost inevitably results in higher rates of hypoglycaemia unawareness, currently affecting approximately 25% of patients with type 1 diabetes. Although the incidence of severe hypoglycaemia is lower in type 2 diabetes, it may approach the incidence in type 1 diabetes, when type 2 diabetes advances and glucose counter regulation fails. This thesis is sited at the cutting edge of increasing automobile mobility and changes in incidence and treatment of diabetes. Driving a car is a complex task, in which technological, psychological and physical factors may play a role. Most drivers consider themselves better drivers than average. Traffic can arouse various, often intense, emotions, and many people have unambiguous opinions about traffic. This may also be the case because in traffic certain risks are involved for both the driver and other participants. Throughout the world restrictive legislature concerning diabetic drivers has been issued, and currently, the debate on the issue of traffic safety of patients with diabetes mellitus is rising on national and international political as well as scientific levels. Generally, (professional and public) opinions as well as legal restrictions regarding diabetes and driving are mainly prompted by the impending danger of hypoglycaemia during driving. Opinions may also be influenced by anecdotal reports and by media attention to road traffic accidents where diabetic patients, possibly hypoglycaemic, are involved. Recently, in the United States of America, one such event has even resulted in a National Transportation Safety Board Public Hearing on Medical Oversight of Non-Commercial Drivers (March 3, 2003). Diabetes en autorijden : rijvaardigheid, besluitvorming en juridische aspecten. Wettelijk gezien, mogen mensen met diabetes een rijbewijs hebben, als zij aan bepaalde eisen voldoen. Met betrekking tot sommige voorwaarden voert het Centraal Bureau Rijvaardigheidsbewijzen (CBR) echter een gedoogbeleid. Promovendus Alexander Stork onderzocht de rijvaardigheid van diabetici door middel van een rijsimulator bij TNO in Soesterberg. Hij is van mening dat diabetici verplicht moeten worden hun aandoening te melden bij het CBR. In Nederland leven 850.000 mensen met diabetes. Mensen met diabetes kunnen veilig autorijden, zowel met normale als met matig verlaagde bloedglucosespiegels (hypoglycaemie). Daarentegen wordt de beslissing om geen auto te rijden met een verlaagde bloedglucosespiegel niet altijd adequaat genomen, met name niet door patiënten met type 2 diabetes die hiervoor tabletten gebruiken. Als de wet exact toegepast wordt, zouden veel mensen met diabetes, die lage bloedglucosewaarden niet goed aan voelen komen, geen rijbewijs mogen hebben. In de praktijk voert het CBR echter een gedoogbeleid. Stork vindt dat dit gedogen wettelijk moet worden vastgelegd. Aan de andere kant vindt hij dat diabetici verplicht moeten worden hun aandoening te melden bij het CBR. (Author/publisher)
Abstract