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Intervention may reduce driving mishaps in high-risk adults with type 1 diabetes
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Adults with type 1 diabetes determined to be at high risk for driving mishaps or vehicle collisions experienced fewer accidents behind the wheel after participating in an online intervention, according to published findings.
“In recognition of this increased rate of mishaps among drivers with type 1 diabetes, the American Diabetes Association released a position statement on diabetes and driving, which recommended that clinicians should screen for elevated risk and intervene to reduce it,” Daniel J. Cox, PhD, AHPP, professor of psychiatric medicine and professor of internal medicine at the University of Virginia School of Medicine in Charlottesville, Virginia, and colleagues wrote. “However, no specific screening tool or intervention is available.”
The researchers developed and tested a brief questionnaire, the Risk Assessment of Diabetic Drivers (RADD) scale, that would allow a clinician to screen drivers with type 1 diabetes for a high risk of driving mishaps. Researchers also developed an online intervention intended to help high-risk drivers to better anticipate, prevent and treat hypoglycemia while driving.
To develop the assessment, Cox and colleagues analyzed data from 371 drivers with type 1 diabetes from three U.S. regions who completed a series of established questionnaires about diabetes and driving, including the hypoglycemia awareness scale and visual acuity and peripheral vision screening. Participants also recorded their driving mishaps over the next 12 months (mean age, 43 years; 48% men; mean diabetes duration, 24.5 years; mean HbA1c, 7.8%). Questionnaire items that uniquely identified drivers who did and did not have subsequent driving mishaps were assembled into the RADD scale.
In a second study, 1,737 drivers with type 1 diabetes from all 50 states completed the RADD online (mean age, 40 years; 48% men; mean reported range of miles driven, 12,000-14,000 per year). Among these, 118 low-risk and 372 high-risk drivers qualified for and consented to participate in a 2-month treatment protocol followed by 12 monthly recordings of driving mishaps.
Researchers randomly assigned the high-risk participants to the online intervention (n = 253) or to usual care (n = 122); half of the intervention participants also took part in a motivation interview at the beginning and end of the treatment period. All low-risk participants received usual care. Participants assigned to the online intervention had 70 days to complete the program, which consisted of five units and three “homework” activities to complete with each unit. The primary outcome was driving mishaps, defined as collisions, moving vehicle violations, episodes of severe hypoglycemia while driving, loss of vehicle control and instances of impaired driving in which someone else took over driving.
Researchers found that the RADD demonstrated 61% sensitivity and 75% specificity; participants in the upper third of the RADD distribution (high-risk) reported 3.03 driving mishaps per driver per year vs. 0.87 for those in the lower third (low-risk).
In the second study, high-risk participants reported a mean 4.3 mishaps per driver per year; low-risk participants reported a mean 1.6 mishaps per driver per year (P < .001 for both).
Compared with high-risk drivers who received usual care, those assigned to the online intervention reported fewer hypoglycemia-related driving mishaps (P = .01) but more than low-risk participants receiving usual care, reducing the difference between the high-risk and low-risk participants receiving usual care by 63%, according to the researchers. Those assigned to the online intervention reported 1.58 times more mishaps vs. the low-risk group receiving usual care (P = .026). Motivational interviews did not affect participation or efficacy, the researchers reported.
The researchers noted that the improvement in hypoglycemia-related driving mishaps cannot be attributed to changes in general attitudes and self-reported behaviors, as participants in both the intervention and usual care groups showed improvements in those measures.
“It is also important to note that [the online intervention] only affected hypoglycemia-related driving mishaps, not hyperglycemia or non-diabetes-related mishaps,” the researchers wrote. “Together, these data suggest that [the online intervention] had the specific effect intended: reducing the occurrence of hypoglycemia-related driving mishaps.”
The ADA will soon host the RAAD questionnaire on its website, according to the researchers. – by Regina Schaffer
Disclosure: LifeScan and Abbott Laboratories provided some blood glucose measurement supplies for this study, which was funded by a NIDDK grant. The researchers report no relevant financial disclosures.
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