Hypoglycemia, diabetes therapies and driving categories in type 2 diabetes

Abstract

Objective: To assess the experiences of hypoglycemia in drivers with type 2 diabetes according to types of diabetes treatment; to determine experiences in different driving groups; and to ascertain whether UK-based Driving and Vehicle Licensing Agency (DVLA) guidance concerning hypoglycemia and driving is understood. Research, design, and methods: An online questionnaire was sent to UK drivers with type 2 diabetes between June and September 2014. Study limitations included selection bias inherent in online surveys, and lack of validation of the definition of hypoglycemic symptoms by an expert patient group. Results: The survey was completed by 1569 (457 social, 590 commuters, and 522 business/work) drivers. Vocational drivers were more likely to be treated with an insulin secretagogue (sulfonylureas and glinides) (52%) than diet alone (18%), a non-insulin secretagogue (26%) or insulin (16%). Symptoms of hypoglycemia (both mild and severe) were reported by 62% of the total cohort in the past year. Risk was greatest in those with poor diabetes self-management behavior and those receiving an insulin secretagogue. Among the 1112 respondents commuting or driving for a living, 16.8% had poor, 49.6% average, and 33.6% good diabetes self-management. Poor self-management was more frequent among vocational drivers and those receiving insulin secretagogues. Following a hypoglycemic episode, only 24% of insulin-secretagogue-treated drivers and 39% of insulin-treated drivers would discontinue driving for the DVLA-recommended 45 minutes. Insulin-treated drivers were best informed about diabetes and driving. Healthcare providers were the preferred source of information on driving and diabetes for 78% of drivers. Conclusion: Hypoglycemia risk is highest among drivers with poor diabetes self-management, those commuting or driving for a living and those taking insulin secretagogues. There is an educational need for all drivers concerning driving and hypoglycemia.

Keywords:

• Driving
• hypoglycemia
• insulin secretagogues
• type 2 diabetes

Transparency

Declaration of funding

This study was funded by Merck Sharp & Dohme Ltd.

Declaration of financial/other relationships

M.D.F. has disclosed that he has received financial support for speaker meetings, consultancy or research from pharmaceutical companies including MSD, Merck, AstraZeneca, Pfizer, Sanofi, J&J, Novartis, sanofi-aventis and Novo Nordisk. H.L. has disclosed that she is an employee of MSD. M.E. has disclosed that he has received research grants from Novo Nordisk, Sanofi and Takeda, and has participated in Advisory Boards, and received speaker fees and honoraria from Novo Nordisk, Sanofi, Jansen, Novartis, and MSD.

CMRO peer reviewer 1 has disclosed that he is the recipient of research/grant funding from GlaxoSmithKline, Novartis, Novo Nordisk, Takeda, AstraZeneca, NIH, sanofi-aventis, Eli Lilly and Daiichi-Sankyo; is a consultant to, and lecturer for, GlaxoSmithKline, Novartis, Takeda, sanofi-aventis, Eli Lilly and Daiichi-Sankyo; and is on the speakers bureau for Novo Nordisk and sanofi-aventis. CMRO peer reviewer 2 is a consultant to AstraZeneca. Peer reviewer 3 has no relevant financial or other relationships to disclose.

Acknowledgments

The concept of this manuscript was developed in collaboration with the authors and MSD (Merck Sharp & Dohme Ltd). The market research survey through Kantar Health was fully funded by MSD. The authors were supported by an independent medical writer, Jenny Grice, who was fully funded by MSD. The authors, including an author from MSD, had complete editorial control over the manuscript, which represents the views of the authors.