EU drivers may be failing to report hypos due to new licensing rules

by Barbara Hewitt on October 20, 2014

People with type 1 diabetes in European Union countries are likely failing to report severe hypos experienced while driving because they face losing their licence, new research has found.

Rules introduced in 20102 under the EU Third Directive on Driving (2006) mean that if they report two or more severe hypoglycaemic events, defined as an episode requiring assistance for recovery, their driving license should be withdrawn.


Drivers in the EU may lose their license if they report two or more hypos in a single year

But research suggests that type 1 diabetics experiencing recurrent severe hypos have stopped reporting these episodes to their diabetes care team as a result of the new regulations.

The study from Denmark says that the unintended consequences of this change may be dangerous because of the potential for an increase in traffic accidents.

Prior to the new regulations, patient reporting of hypoglycaemic events was ad hoc, and this depended on the clinician, the patient, and their mutual relationship, according to lead author Dr. Ulrik Pedersen-Bjergaard of the Nordsjællands Hospital Hillerød in Denmark.

‘The clinician could prohibit driving temporarily based on a general medical judgment. Authorities were informed only if the patient did not comply with the clinician’s instructions,’ he explained.

But now patients are expected to report to their clinician, who is responsible for taking appropriate action and who will inform authorities in case of noncompliance with the restrictions. This could jeopardize doctor-patient relations, according to Dr. Pedersen-Bjergaard.

‘When the clinician is put in the position to be the person determining whether the patient can maintain their driving license, it is a serious threat against the clinician-patient relationship that may result in poorer treatment results and increased risk of road accidents,’ he commented.

‘The problem is that severe hypoglycaemia is not a disease per se, but rather a side effect of the life necessary treatment for these patients with type 1 diabetes,’ he added.

Dr. Pedersen-Bjergaard and colleagues conducted a retrospective cohort study, including data on a total of 309 patients with type 1 diabetes attending the outpatient clinic at Nordsjællands University Hospital Hillerød, between 2010 and 2012.

Data from medical records in 2012 were compared with those from 2010 and 2011 and with data from an anonymous questionnaire. Researchers found that reported rates of severe hypoglycaemia in the medical records were reduced by 55% in 2012 compared with the prior years. The proportion of people reporting recurrent episodes was grossly reduced from 5.6 to 1.5%. And compared with anonymous reporting in the questionnaire, the rate of severe hypoglycaemia in 2012 was 70% lower.

‘Reporting of severe hypoglycaemia by patients with type 1 diabetes significantly reduced following the implementation of EU driver’s licensing legislation that implies withdrawal of driver’s licensing in case of recurrent episodes within one year,’ the study report says.

‘The resulting burden of concealed severe hypoglycaemia may impair the safety of affected patients and unintentionally paradoxically reduce general traffic safety,’ it concludes.

According to Dr. Brian Frier of the University of Edinburgh, who is the chairman of the UK National Driving Panel on Diabetes, it is likely that a similar problem exists in many countries.

He explained that although the new regulations are ‘evidence based’, the Danish study reveals a serious limitation regarding the honesty of patients’ declaring recurrent hypoglycaemia. He added that in the UK, a diabetic reports hypoglycaemia episodes to the driving authority, so that the doctor/patient relationship is not affected.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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