The recent article “Diabetes and Driving” (1) was the most comprehensive review of this subject that I have encountered. It concluded with the recommendation that further studies be performed to identify high-risk groups of diabetic subjects and that interventions take place for reducing the risk of motor vehicle accidents.
Although beyond the scope of the cited review, there is certainly one benign intervention that is appropriate even before new evidence appears: check blood glucose before driving and hourly thereafter while driving. A corollary to this intervention would be to correct blood glucose to a target value with calibrated glucose tablets or liquid glucose whenever it is below target. This should at least apply to patients using insulin, incretin mimetics, and sulfonylureas or similar medications that stimulate endogenous insulin production. Typically, 1 g glucose will raise blood glucose by ∼5 mg/dl for a diabetic patient weighing ∼70 kg (2).
The above instructions should be immediately, albeit belatedly, incorporated into the American Diabetes Association guidelines for blood glucose self-monitoring.
I have given these instructions to diabetic patients since the advent of blood glucose self-monitoring in 1969 and cannot understand why this protocol is still not universal. While we await further evidence, lives continue to be lost due to circumstances involving diabetic drivers.
