An overview of a study published about predicting and reducing driving mishaps among drivers with type 1 diabetes.
by Dr Steven Trawley
It has been observed that people with type 1 diabetes are at higher risk when driving due to hypoglycaemia (Cox et al, 2003 ) . This emphasises the importance of not only identifying drivers who need support but also what support to provide. In a recent paper  in Diabetes Care, Prof Daniel Cox (University of Virginia) and colleagues have attempted to address both issues in two large studies of drivers with type 1 diabetes.
In the first study, 371 drivers with type 1 diabetes were given several questionnaires that included topics such as fear of hypoglycaemia and history of hypoglycaemia-related driving mishaps. These drivers were then followed-up monthly for a year and asked to report any driving mishaps. At this point, the authors conducted a retrospective analysis which highlighted 11 questions that predicted which drivers would experience problems with their driving due to hypoglycaemia. These 11 questions were then assembled into the Risk Assessment of Diabetic Drivers (RADD) scale.
In the second study, the authors used the RADD to assess the effectiveness of a new road safety intervention for at-risk drivers with type 1 diabetes. The online intervention DiabetesDriving.com (DD.com) intervention was designed to enable drivers to better anticipate and prevent, detect and treat hypoglycaemia while driving. The intervention included five online educational units addressing a variety of topics including anticipating/preventing hypoglycaemia and general driving safety. In addition, all drivers were sent a toolkit for their car, which included a pre-drive checklist, rapid-acting and long-acting glucose sources, blood glucose driving benchmark keychain and stickers, and a blood glucose meter. A total of 253 drivers received the toolkit and access to the online DD.com program. A further 240 drivers were assigned to a routine care condition where they received no toolkit or access to the online program. All participants were categorised as low or high risk in terms of driving safety, based on their responses to the RADD.
After 12 months, the authors found that high risk drivers who participated in the DD.com program reported significantly fewer hypoglycaemia-related driving mishaps than high risk drivers receiving routine care. Overall, the difference in driving mishaps between the low and high risk groups was reduced by 63%. Interestingly, driver feedback indicated that the initial educational unit and the toolkit were the most helpful aspects of the intervention.
These findings suggest that the beneficial effect of DiabetesDriving.com could be reduced to a briefer (30-minute) and cheaper online educational unit and toolkit. Dr Steven Trawley  and his ACBRD colleagues are now collaborating with Prof Cox to evaluate this brief version in Australia, with a grant from the ADEA Research Foundation  and in-kind support from Roche Diabetes Care.To take part in the study, please visit diabetesdrivingoz.com  or for information about this project please contact Dr Steven Trawley .
Cox DJ, Gonder-Frederick LA, Singh H, Ingersoll KS, Banton T, Grabman JH, Schmidt K and Clarke W. Predicting and reducing driving mishaps among drivers with type 1 diabetes . Diabetes Care, 2017; 40(6): 742-750.