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The legal requirements for diabetes and driving are outlined in the Waka Kotahi (New Zealand Transport Authority) guidelines – please refer.
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The following includes important points relevant to type 2 diabetes including mandatory requirements and factors to consider.
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Current Waka Kotahi (New Zealand Transport Authority/NZTA) guidelines recommend that annual assessment is required for class 2,3,4 and 5 licence applications or P,V,I or O endorsements for patients with type 2 diabetes on insulin and/or sulfonylureas. These assessments and any other assessments around diabetes and driving can now be performed by GPs or physicians, nurse practitioners or diabetes nurse specialists in secondary care.
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Factors to consider for fitness to drive:
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Cataracts and previous panretinal photocoagulation may disproportionately affect night vision
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Peripheral vascular disease and neuropathy
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Risk of hypoglycaemia
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Typically only relevant if on insulin and/or sulfonylureas
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Risk is low if episodes of hypoglycaemia are rare, there is no hypoglycaemic unawareness and patients regularly monitor their glucose levels (especially around driving)
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Risk is also reduced by a regular pattern of shifts with adequate meal breaks
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Other common comorbidities such as:
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Ischaemic heart disease and cerebrovascular disease
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Obstructive sleep apnoea and any associated daytime somnolence
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Cognitive impairment
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Patients on insulin and sulfonylureas must ensure their glucose levels are > 4.2 mmol/L before they drive (often easier to say ‘above 5 safe to drive or above 5 to stay alive’). They should also be advised:
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To stop driving and to check their glucose levels every 2-3 hours on long trips or immediately if symptoms of hypoglycaemia
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To ensure their glucometer and treatment for hypoglycaemia is available at all times
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The law states that patients must not drive for one hour after an episode of mild hypoglycaemia (< 4 mmol/L) and not for 24 hours after an episode of insulin-induced severe hypoglycaemia (requiring assistance) or 48 hours after an episode of sulfonylurea-induced severe hypoglycaemia. Patients who have an episode of severe hypoglycaemia whilst driving cannot drive for 1 month. Remedial action and specialist review is almost always required before the patient can return to drive.
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There is no legal cut-off for hyperglycaemia and driving. However, patients should be advised not to drive if they feel unwell or if they have impaired decision making.
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Criteria for referral for specialist assessment:
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Specialist review is no longer mandatory for any assessment of driving licences or endorsements in people with diabetes but consider if:
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Hypoglycaemic unawareness
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Severe hypoglycaemia whilst driving
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Frequent episodes of mild hypoglycaemia
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Any other doubts over the patient’s ability to drive e.g. degree of peripheral neuropathy