This report provides a comprehensive review of past and current research on the effects of medical conditions on driving performance. It is divided into 15 sections (Introduction, Vision, Hearing, Cardiovascular Diseases, Cerebrovascular Diseases, Peripheral Vascular Diseases, Diseases of the Nervous System, Respiratory Diseases, Metabolic Diseases, Renal Diseases, Musculoskeletal Disabilities, Psychiatric Diseases, Drugs, The Aging Driver, and The Effects of Anesthesia and Surgery). Each section provides a brief overview of the condition/illness; prevalence information; review of the medical, gerontological, and epidemiological literature relevant to medical conditions and driving; followed by current fitness to drive guidelines from Australia and Canada for the condition/illness. An appendix contains preliminary guidelines developed to assist physicians in determining when patients have medical conditions that can affect fitness-to-drive.
This report is a scholarly but practical compendium that can serve as a valuable resource for physicians, rehabilitation practitioners, other allied health care professionals and educators, Department of Motor Vehicle personnel, road and traffic safety personnel, transportation planners, highway safety researchers, and public policymakers. Its value is particularly relevant as the driving population increases in size and age.
We reproduce the fifth (and final)
part of the diabetes sections below.
Section 9: Metabolic Diseases
Predictors of Hypoglycemia Unawareness
A number of studies have examined factors that may be associated with hypoglycemic unawareness. A summary of the literature is provided in Table 28. As can be seen, factors that may be associated with hypoglycemic unawareness include age, duration of diabetes, presence or absence of autonomic neuropathy, species of insulin, degree of metabolic control, and hypoglycemia itself. To date, most studies that have examined hypoglycemic unawareness in individuals with diabetes have relied on questionnaires to classify subjects, a methodology which may limit the findings. Gerich et al. (1991) suggest that in future investigations, subjects should be categorized on the basis of prospectively obtained objective criteria such as glycemic thresholds for development of autonomic symptoms obtained during a standardized insulin infusion test.
Although a number of factors have been proposed to be associated with hypoglycemia unawareness, there is a paucity of literature addressing this issue. More research is needed before any definitive statements can be made regarding risk factors for hypoglycemia unawareness. Nevertheless, hypoglycemia unawareness is a major risk factor for the development of severe hypoglycemia and therefore should be a major concern for individuals with diabetes who drive.
Table 28 Summary of Studies Examining Possible Predictors of Hypoglycemia
Hepburn et al. (1990) |
Hepburn et al. (1990)
Mokan et al. (1994)
Ward et al. (1990) |
Cryer & Gerich (1983)
Heller et al. (1987)
Hoeldtke et al. (1982)
Sussman et al. (1963) |
↑ Risk:
Teuscher & Berger (1987)
No Difference:
Egger et al. (1991)
Gale & Tattersal (1979)
Jones et al. (1991)
Muhlhasser et al. (1991)
Orchard et al. (1991)
Schwarz et al. (1990) |
Mokan et al. (1994) |
Banting et al. (1923)
Goldfein et al. (1961)
Heller & Cryer (1991)
Joslin et al. (1924)
Maddock & Trimble (1928)
Widom & Simonson (1990) |
From the US DOT: Medical Conditions and Driving: A Review of the Literature (1960 - 2000)
undated webpages
http://www.nhtsa.dot.gov/people/injury/research/Medical_Condition_Driving/pages/Sec9-PHU.htm
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