Web-Based Tool Prevents Diabetes-Related Driving Mishaps

Miriam E. Tucker

June 20, 2014

SAN FRANCISCO — An investigational interactive website can both assess the driving ability of a person with type 1 diabetes and deliver an intervention that cuts their chances of having a driving mishap by more than 50%, a randomized clinical trial finds.

The results were presented here at the American Diabetes Association (ADA) 2014 Scientific Sessions by Daniel J. Cox, PhD, professor in the departments of psychiatry and internal medicine at the University of Virginia, Charlottesville.

The site, www.DiabetesDriving.com, once completed, could be accessed by physicians and patients. After individuals at risk are identified, the site guides the user through an educational program that teaches ways of preventing diabetes-related driving mishaps and managing problems if they arise.

The site would facilitate the ADA's recommendation to regularly assess driving ability in diabetes patients (Diabetes Care. 2014;37:Supplement 1:S97-S103), and the University of Virginia team has been in talks with the ADA to have the organization disseminate the tool, Dr. Cox told Medscape Medical News.

"We want to work with the diabetes community and make this widely available," he said.

Session moderator Jeffrey S. Gonzalez, PhD, associate professor of psychology, medicine, epidemiology, and public health at Yeshiva University, Albert Einstein College of Medicine, New York, praised the tool and the work of Dr. Cox, who has been studying diabetes and driving for more than 2 decades (Diabetes. 1993;42:239-243).

"I think it was a very impressive study. It's just really gratifying to see how he was able to identify a problem that few people working in diabetes behavioral science were paying attention to and that has clear importance for patients.

"He took a very practical approach thinking how to develop a program that would be effective and also potentially reach the widest number of patients who could benefit from it. It was a really inspiring set of findings," Dr. Gonzalez told Medscape Medical News.

Driving Change: "Tool Kit" Is Most Useful Item

DiabetesDriving.com is an interactive site based on "active learning," using tools such as daily emails and personal contracts. The intervention mode consists of 5 educational units completed at least a week apart:

  • Use of a "tool kit" that is kept in an accessible place in the car at all times.

  • General issues about diabetes and driving.

  • Preventing extreme blood glucose levels (low or high) while driving.

  • Detecting and managing extreme blood glucose levels while driving.

  • Sustaining safer lifelong driving habits.

Driving "mishaps" are defined broadly, including collisions, citations, severe hypoglycemia while driving, someone else having to take control of the car, unintentionally stopping driving, and losing control without hitting anything.

A total of 1768 patients with type 1 diabetes from all 50 US states registered with the site and were screened as high or low risk based on a questionnaire entitled Risk Assessment for Diabetic Drivers (RADD). A total of 379 high-risk and 122 low-risk patients were included in the study and completed monthly online driving diaries for a year.

The group identified as high risk had 258% more driving mishaps in a year than did those considered by the site to be low risk (between 2 and 3 mishaps vs 6 to 7; P < .001). The high- and low-risk groups were similar in gender, age, and, somewhat surprisingly, use of continuous glucose monitoring (CGM). However, patients who used CGM also had higher RADD scores, Dr. Cox noted.

The low-risk group received routine care, while the 379 high-risk patients were randomized to 1 of 3 further groups: routine care, DiabetesDriving.com, or DiabetesDriving.com plus motivational interviews before and after the 12-month intervention, aimed at engaging them further in the use of the tool.

After 12 months, both DiabetesDriving.com groups experienced 53% fewer mishaps than did the high-risk controls (3 to 4 vs 6 to 7, P < .001), with no difference between those who did and didn't receive the motivational interviewing.

There was also no "dose-response" relationship between the number of units completed and the number of mishaps. This was due in large part to the fact that when asked what about the intervention was most helpful to them, a majority of patients cited the tool kit, which was covered in unit 1.

The tool kit consists of several items placed into a clear plastic ziplock bag, including a small blood glucose meter and strips, glucose gel, cheese crackers, and a logo to put in the car window identifying the driver as having diabetes (for police to see). Also included is a laminated checklist similar to those used by pilots, guiding the driver though the determination of current blood sugar level, the likelihood of low blood sugar, and assessment of the need to prevent or treat.

Use of DiabetesDriving.com by the high-risk patients reduced their elevated risk of mishaps by 75% (P < .001), although their risk still remained significantly higher than the low-risk group (3 to 4 vs 2 to 3 mishaps; P < .05).

Next Steps: Fine-tuning the Website

Dr. Gonzalez suggests that patients could use the website at home prior to the medical visit or on an iPad in the waiting room. "And those identified at risk could be given a packaged tool kit, which sounds to me like the active ingredient of the intervention."

Dr. Cox said during his presentation that his team is now working to improve the sensitivity and specificity of the Risk Assessment for Diabetic Drivers and improve/simplify the site.

He told Medscape Medical News that the question of whether there would be a cost to use the site is still being discussed, but if there is it probably wouldn't be too expensive.

"The beauty of internet interventions is that there's a big cost up front — the [National Institutes of Health] has paid for that — but the actual maintenance and delivery is relatively trivial."

The study was funded by the National Institutes of Health, with donation of products from Lifescan, Dex4, and Abbott. Dr. Cox has reported no further relevant financial relationships. Dr. Gonzalez has reported no relevant financial relationships.

American Diabetes Association 2014 Scientific Sessions; June 16, 2014. Abstract 260-OR.

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