VIENNA – A web-based program halved the number of driving incidents experienced by patients with type 1 diabetes deemed at high risk for motoring accidents in a randomized trial.
The annual rate of driving mishaps was around 6 for diabetic drivers identified as being at high risk of future “driving mishaps” and who were randomized to the novel Internet intervention in addition to their routine care, compared with 3 for those at high risk who received usual care.
“Driving mishaps included collisions and moving vehicle violations,” said study investigator Daniel Cox, Ph.D., at the annual meeting of the European Association for the Study of Diabetes.
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Car accidents caused by diabetic drives were less common after a web-based intervention.
Dr. Cox, a clinical psychologist at the University of Virginia, Charlottesville, added that driving mishaps also included any event that could lead to a collision, such as severe hypoglycemia, someone else having to take control of the car, automatic driving, unintentionally stopping driving, and losing control of the vehicle but not actually hitting anything.
Participants were identified as being at high risk of future diabetes-related driving incidents using the 11-item Risk Assessment for Diabetic Drivers (RADD) questionnaire, which was developed by the investigators on the basis of responses from 500 individuals to questions on driving exposure, diabetes control, and the frequency of driving mishaps over the course of a year.
Peripheral neuropathy in the lower limbs was the most potent predictor of future driving mishaps, while hypoglycemia unawareness did not really rank, Dr. Cox observed, adding that RADD had 61% sensitivity and 75% specificity to differentiate diabetic drivers at high and low risk of a future driving mishap.
The study involved screening more than 1,700 drivers with type 1 diabetes who had registered with DiabetesDriving.com. Of these, 122 were identified via RADD as being at low risk of future driving mishaps and were included as a control group, while 379 were identified as being at high risk and were randomized to one of three groups: The first group continued to receive routine care, the second received the intervention in addition to routine care, and the third received the Internet intervention, routine care, and motivational interviewing conducted by telephone before and after using the web-based program.
At baseline, all participants underwent psychometric testing, and then they completed the intervention over a 2-month period. They were then asked to complete monthly online diaries to document any driving mishaps that may have occurred.
DiabetesDriving.com is an interactive, Internet intervention based on active learning. There are five sections to the program. The first provides participants with an overview on how to use a simple diabetes ‘tool kit’, which consists of a series of items contained in a plastic bag to keep in the car. Items in the kit include a key chain with a traffic light system giving guidance on blood glucose levels and whether it is safe to drive or not, a predrive checklist, a glucose meter, a fast-acting dextrose preparation, long-acting carbohydrates in the form of cheese crackers, and a car sticker to alert authorities in the event of a driving mishap.
Other sections of the program cover general issues on diabetes and driving, and how to detect, prevent, and manage extreme blood glucose levels while driving. The final section focuses on how safer driving habits can be sustained in the long term.
Results showed that RADD could be used to distinguish patients with type 1 diabetes at low and high risk of driving mishaps, with the latter having 258% more driving incidents than the former, a statistically significant difference. The basic demographics (i.e., age and gender) and the use of continuous glucose monitoring devices were similar between high- and low-risk patients.
There were 53% fewer driving mishaps among the high-risk diabetic drivers who underwent the intervention, compared with those who did not, Dr. Cox reported. “Motivational interviewing did not significantly influence the outcome,” he reported, and so the additional costs of this cannot be justified in this setting.
Interestingly, it did not seem to matter if drivers completed the whole program or just some of the sections. That said, completing the first section of the program was the most important element overall.
Drivers at high risk for driving mishaps can reduce future mishaps by using DiabetesDriving.com, Dr. Cox concluded. There is now a need to improve RADD’s sensitivity and specificity and to optimize the intervention, he added, which would help with the wider dissemination and use of the program in the diabetes community.