Transcript Document

Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
DVLA Guidance &
Diabetes
Janet Bellis
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Driving licensing, Diabetes &
Hypoglycaemia
• Diabetes is a medical condition which, dependent
upon treatment, may require notification by law to
the Driver and Vehicle Licensing Agency (DVLA)
• Hypoglycaemia is the main hazard when driving and
can occur with diabetes treated with insulin or
tablets or both
• Many of the road accidents caused by hypoglycaemia
are because drivers ignore or are unaware of the
warning signs of hypoglycaemia
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Hypoglycaemia-related road traffic
accidents in the UK
• Approximately 5 fatal hypoglycaemic road traffic
accidents per year
• 25–30 serious hypoglycaemia related road traffic
events per month
(information from police notifications to DVLA, 2009)
http://www.newcastle-diabetes.webeden.co.uk/#/diabetes-driving/4560938631. Last accessed 4th April 2012
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Hypoglycaemia Defined
Documented symptomatic hypoglycaemia
• An event during which typical symptoms of
hypoglycaemia are accompanied by a measured plasma
glucose concentration ≤3.9 mmol/l
Asymptomatic hypoglycaemia
• An event not accompanied by typical symptoms of
hypoglycaemia but with a measured plasma glucose
concentration ≤3.9 mmol/l
American Diabetes Association Workgroup on Hypoglyceamia Diabetes Care May 2005 vol. 28 no. 5 1245-1249
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Hypoglycaemia Defined
Relative hypoglycaemia
• An event during which the person with diabetes
reports any of the typical symptoms of
hypoglycaemia, and interprets those as indicative of
hypoglycaemia, but with a measured plasma glucose
concentration >3.9 mmol/l.
American Diabetes Association Workgroup on Hypoglyceamia Diabetes Care May 2005 vol. 28 no. 5 1245-1249
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
What is a reportable severe
hypoglycaemic episode?
• Hypoglycaemia requiring the assistance from
another person at any time of day or night
• The requirement of assistance includes
– Admission to A&E
– Treatment from paramedics
– Assistance from 3rd party who has to administer
glucagon/glucose because the person cannot do so
themselves.
• It does NOT include another person giving
assistance in circumstances where the person was
aware of his/her hypoglycaemia and able to take
appropriate action independently.
Diabetes UK 2011 Driving and the new medical standards for people with diabetes
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Common symptoms of hypoglycaemia
Autonomic
Neuroglycopenic
General malaise
Sweating
Confusion
Headache
Palpitations
Drowsiness
Nausea
Shaking
Odd behaviour
Hunger
Speech difficulty
Incoordination
Edinburgh Hypoglycaemia Scale in which the 11 most commonly reported symptoms were incorporated
McAulay. Diabetic Medicine 2001;18:690–705
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Hypoglycaemia & cognitive function
• Cognitive function can start to deteriorate when
blood glucose levels drop below the region of
3.0 mmol/l
• Complex tasks are consistently impaired
– Memory & attention
– Concentration/abstract thought
– Rapid decision making
– Hand-eye coordination
• Cognitive function does not fully recover for at
least 45 minutes after hypoglycaemia
Warren and Frier. Diabetes, Obesity and Metabolism, 7, 2005, 493–503
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Hypoglycaemic Unawareness
• Impaired awareness of hypoglycaemia has been
defined by the Secretary of State's Honorary
Medical Advisory Panel on Driving and Diabetes
as,
'an inability to detect the onset of
hypoglycaemia because of a total absence
of warning symptoms'.
DVLA Swansea, Dec 2011. At a glance: Guide to the current Medical Standards of Fitness to Drive p.29
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Driving Regulations
• 1st January 1998 – New driving restrictions introduced
in the UK, to bring UK in line with other European
countries
• People with diabetes on insulin had a licence requiring
revalidation a maximum of every 3 years
• Normal licence ran until the age of 70 years
• Since 15th November 2011, new driving regulations
have been implemented
http://www.diabetes.org.uk/Guide-to-diabetes/Living_with_diabetes/Driving
http://www.iddt.org/about/living-with-diabetes/driving/driving-regulations-in-the-uk/
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Driving Licences:
Classification in Europe
There are two groups of licence holders and the medical
standards differ according to each group:
• Group 1 includes motorcars and motorcycles
– Aged 17-70 years
• Group 2 concerns vocational vehicles and includes
large lorries (category C) and buses (category D)
– Aged 21-45 years, then every 5 years to 65 years
http://www.direct.gov.uk/en/Motoring/DriverLicensing/WhatCanYouDriveAndYourObligations/DG_4022547
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 1: managed by diet alone
• Need not notify DVLA unless develop relevant
disabilities e.g. diabetic eye problems affecting
visual acuity or visual field or if insulin required.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 1:
Managed by tablets associated with a risk
of hypoglycaemia (includes SUs & glinides)
If all of the following requirements are met DVLA does
not require notification:
• Must not have had more than one episode of
hypoglycaemia requiring the assistance of another
person within the preceding 12 months.
• Must not suffer a single severe hypoglycaemia event
while driving.
• Must not have hypoglycaemic unawareness
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 1:
Managed by tablets associated with a risk
of hypoglycaemia (includes SUs & glinides)
• Must have no other debarring complications of
diabetes such as a visual field defect.
• Must not be considered at high risk of developing
severe hypoglycaemia by self or medical team.
• It is advised but not required to monitor blood
glucose regularly and at times relevant to driving to
enable the detection of hypoglycaemia. A medication
review should also take place.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 1: managed by tablets other than
those on the previous page or by noninsulin injectable medication
If all the following requirements are met, and they are
under regular medical review, DVLA does not require
notification:
• Must not have had more than one episode of
hypoglycaemia requiring the assistance of another
person within the preceding 12 months.
• Must not suffer a single severe hypoglycaemia event
while driving.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 1: managed by tablets other than
those on the previous page or by noninsulin injectable medication
• Must not have hypoglycaemic unawareness
• Must have no other debarring complications of
diabetes such as a visual field defect.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 1: Insulin treated
Drivers treated with any insulin preparation MUST inform
the DVLA.
However, they can apply for and be granted a 1, 2, or 3
year Group 1 licence if the following criteria are met:
• Must have awareness of hypoglycaemia.
• Must not have had more than one episode of
hypoglycaemia requiring the assistance of another person
in the preceding 12 months.
• Must not be regarded as a likely source of danger to the
public while driving.
• Must meet the visual standards for acuity & visual field
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 1: Insulin treated
• Must not be considered at high risk of developing
severe hypoglycaemia by self or medical team.
• Must not have a single episode of severe
hypoglycaemia while driving
• MUST have appropriate blood glucose monitoring
– Must always carry glucose meter & blood glucose strips.
– Must check blood glucose before driving and every two
hours whilst driving.
– If blood glucose is 5.0mmol/l or less, take a snack. If
less than 4.0mmol/l or feel hypoglycaemic, do not drive.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 2: managed by diet alone
• Need not notify DVLA unless develop relevant
disabilities e.g. Diabetic eye problems affecting
visual acuity or visual field or if insulin required.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 2: Managed by tablets which
carry a risk of inducing hypoglycaemia
(includes SUs & glinides)
Need to inform the DVLA but can be issued a 1, 2 or 3 year
group 2 licence if meets the following criteria:
• No episode of hypoglycaemia requiring the assistance of
another person has occurred in the preceding 12 months.
• Has full awareness of hypoglycaemia.
• Has sufficient understanding of the risks of hypoglycaemia.
• No other debarring complications of diabetes such as a
visual field defect.
• Required by law to monitor blood glucose at least twice
daily and at times relevant to driving.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 2: managed by tablets other than
those on the previous page or by noninsulin injectable medication
• Drivers need to inform the DVLA but will be issued
a group 2 licence unless they develop relevant
disabilities e.g. diabetic eye problem affecting visual
acuity or visual fields, in which case either refusal,
revocation or short period licence.
• Drivers are advised to monitor their blood glucose
regularly and at times relevant to driving. They must
be under regular medical review.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 2: Insulin treated
Drivers taking any insulin preparation MUST inform the
DVLA.
However, they can apply for and be granted a Group 2 licence
for a maximum of 12 months if the following criteria are met:
• No episode of hypoglycaemia requiring the assistance of
another person has occurred in the preceding 12 months.
• Has full awareness of hypoglycaemia.
• Has sufficient understanding of the risks of hypoglycaemia.
• Is not considered at high risk of developing severe
hypoglycaemia by self or medical team.
• Has no episode of severe hypoglycaemia while driving
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 2: Insulin treated
• Must also have no other debarring complications of
diabetes such as a visual field defect.
• Required by law to monitor blood glucose at least
twice daily and at times relevant to driving using a
glucose meter with a memory function.
• Must have an annual examination by an
independent Consultant Diabetologist
– 3 months of blood glucose readings must be
available.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Police, Ambulance and Health Service
Vehicle Driver Licensing
• The Secretary of State’s Honorary Medical Advisory
Panel on Diabetes and Driving has recommended
that drivers with insulin treated diabetes should
not drive emergency vehicles
• This takes account of the difficulties for an individual,
regardless of whether they may appear to have
exemplary glycaemic control, in adhering to the
monitoring processes required when responding to
an emergency situation.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 1 license holders: key changes
• A group 1 driver who has had two or more episodes
of hypoglycaemia requiring assistance from another
person at any time (including when sleeping) in a
year, must inform the DVLA and be advised not to
drive.
• Previously a single hypoglycaemic event would ban
the person from driving until satisfactory control
certificate obtained from GP.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Group 2 license holders: key changes
• DVLA have now removed the ban for people on insulin driving
Group 2 vehicles and people can now undergo individual
medical assessment to assess their fitness to drive these
vehicles.
• Good news for Group 2 however:
– Must demonstrate 3 months of blood glucose monitoring
before applying
– Additional requirement: using a blood glucose meter with a
memory function
– Must not experience one or more hypoglycaemic
episode(s) requiring assistance of another person in the
previous 12 months.
DVLA 2011 At a glance Guide to the current Medical Standards of Fitness to Drive
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
What to do if your licence is taken away
• If a driving licence is revoked the DVLA can be asked to
reconsider their decision.
• Must appeal within 6 months of the decision to revoke your
licence.
• To succeed, court must be convinced that the incident was
due to most unusual circumstances and that the onset of
another uncontrolled hypoglycaemic episode whilst driving
is unlikely.
• If you have had your licence revoked due to having more
than one disabling hypoglycaemic event in 12 months, you
can reapply for your licence when 12 months have
passed since the penultimate (last-but-one)
hypoglycaemic event.
Diabetes UK 2011 Driving and Diabetes Information Sheet
Date of preparation: April 2012
Job bag number: UK/DB/0412/0176
Summary
• Diabetes and its treatments can adversely affect the ability
to drive safely.
• New regulations issued in 2011 regarding driving licence
standards to bring UK in line with EU Member States
• Key changes:
– Group 1 drivers with two or more episodes of severe
hypoglycaemia (requires the assistance of another person) in a
12 month period MUST inform DVLA and be advised not to
drive
– Group 2 drivers with one or more episodes of hypoglycaemia
(requires the assistance of another person) in a 12 month
period MUST inform DVLA and be advised not to drive
– DVLA have now removed the ban for people on insulin driving
Group 2 vehicles and people can now undergo individual
medical assessment to assess their fitness to drive these
vehicles.