Drivers with type 2 diabetes taking certain drugs could be at higher risk of hypoglycaemia
A newly published report has found that drivers with type 2 diabetes who are taking certain drugs, including sulphonylureas or glinides, could be at higher risk of a hypoglycaemic episode.
A recent MSD-funded (Merck, Sharp and Dohme) online research study surveyed 1,569 UK drivers with type 2 diabetes being treated with different types of diabetes medications. The results showed that hypoglycaemia (or hypos for short) were most common amongst those treated with sulphonylureas or glinides, compared to people taking other treatments.
Dangerous falls in blood sugar levels, known as hypoglycaemia (or hypo for short), is a complication of both type 1 and type 2 diabetes that can make people feel unwell or confused. During a hypo blood sugar is used up too quickly, which means it can rapidly drop.
Better education is needed for doctors and drivers to raise awareness of the risk of driving with type 2 diabetes
Of those surveyed, 78% of people taking sulphonylureas or glinides said they had experienced either a severe or minor hypo in the past 12 months, followed by insulin (68%), diet alone (50%) and other diabetes medications (48%).
In the UK more than 3 million people suffer from diabetes, approximately 90% of which have type 2 diabetes. Around 668,000 type 2 diabetes patients take sulphonylureas or glinides to help manage their condition. Although the draft NICE guideline currently under consultation recognises some of the limitations of sulphonylureas it currently recommends using the insulin secretagogue, repaglinide, first-line for those who cannot tolerate metformin and as a possible second-line combination agent.
Dr Marc Evans, Consultant Physician, University Hospital Llandough, Cardiff said: “These survey results show that hypoglycaemic episodes are common amongst drivers with type 2 diabetes, particularly those treated with medications that stimulate the release of insulin, such as sulphonylureas or glinides. It is therefore puzzling that the new draft NICE recommendations in type 2 diabetes currently recommend a glinide for first-line intensification after or instead of metformin. Individual patient needs, such as lifestyle and work, must be considered when prescribing appropriate treatments to manage type 2 diabetes.”
In a separate survey of 101 UK-based GPs, also funded by MSD, 90% of GPs said that people with diabetes would benefit substantially from individualised care, particularly those at risk of, or the consequences of, hypoglycaemia. The majority (74%) of doctors surveyed said they were aware of hypos associated with sulphonylureas, however, only 27% knew that this could be a problem with glinides.
The current hypos and driving survey also showed that commuters and vocational drivers receiving sulphonylureas or glinides were more likely to have poor diabetes self-management behaviour, such as skipping meals, missing medicine doses and not self-testing blood glucose prior to every journey.
Dr Evans added: “Hypoglycaemia in type 2 diabetes is a real and hugely underestimated problem with potentially very serious consequences. There is a clear need to educate both doctors and drivers regarding diabetes and driving, including the increased risks of hypos with certain treatments and the importance of good self-management.”
Hypoglycaemia affects 38% of people with type 2 diabetes and is associated with reduced quality of life, reduced treatment satisfaction, reduced adherence to treatments and adverse long-term outcomes. The UK Transport Research Laboratory (TRL) recently reported that driving with even mild hypoglycaemic episodes adversely affects domains of cognitive function essential for safe driving and impairs judgement on whether to continue driving or monitor and self-treat. According to police notifications received by the DVLA, there are around five fatal crashes a year involving hypoglycaemia and 45 serious events a month.
DVLA guidance for people with type 2 diabetes can be read here: https://www.gov.uk/diabetes-driving
Read the DRWF leaflet What is diabetes? here
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