Driving-Related Glucose Monitoring Practices Among Insulin-Treated Adults With Type 2 Diabetes

Driving requires complex cognitive, motor, and sensory coordination, all of which may be adversely affected by diabetes. For individuals treated with insulin, hypoglycemia represents the principal safety concern. Although many jurisdictions provide guidance for insulin-treated drivers, adherence to these recommendations remains unclear.

An online survey was conducted among 500 licensed drivers with insulin-requiring type 2 diabetes (T2D) from the United States and the United Kingdom, not using continuous glucose monitoring (CGM). The survey included discrete and open-ended questions relating to diabetes management and driving behaviors. Descriptive and inferential statistical analyses were performed.

Participants were predominantly male (59%, n = 293) with a mean T2D duration of eight years. Insulin regimens included basal-only therapy (54%, n = 257), multiple daily injections (39%, n = 197), and continuous subcutaneous insulin infusion (9%, n = 46). Severe hypoglycemic event(s) in the preceding 12 months were reported by 34%, and 54% had evidence of impaired awareness of hypoglycemia (Clarke score >4). Furthermore, 37% (n = 185) limited their driving due to insulin-related concerns, and 72% (n = 359) worried particularly about hypoglycemia. Only 34% (n = 168) reported checking glucose levels before driving >75% of the time. If feeling hypo before driving, 59% (n = 295) would take a snack but drive immediately. If feeling hypoglycemic while driving, 10% (n = 48) would attempt to 'get to their destination fast'. Only 27% (n = 138) carried fast-acting carbohydrates, and 42% (n = 210) felt safe to drive 'as soon as I feel better' while 32% (n = 163) would 'wait 45 minutes and recheck their glucose levels'.

Potentially unsafe driving behaviors are common among adults with insulin-treated T2D. There appears to be a need to improve the understanding of safe driving guidance.