Diabetes and driving. Performance, decision making and legal aspects

In this thesis, the current state regarding diabetes and driving is discussed, and recommendations for further research are made. Subsequently, studies are described, demonstrating that patients with type 1 diabetes with normal and with impaired hypoglycaemia awareness, as well as patients with type 2 diabetes with normal hypoglycaemia awareness, have normal driving performance during euglycaemia, as well as during moderate hypoglycaemia, although in type 2 diabetic patients more effort is required to do so. However, it is also shown that the decision not to drive during hypoglycaemia is not always adequately made in type 1 patients with impaired hypoglycaemia awareness and by type 2 diabetic patients, particularly when using oral hypoglycaemic agents. The importance of good and tailored patient education is stressed. For methodological purposes, a practical algorithm to establish and maintain euglycaemia is studied. Moreover, the HemoCue glucose analyser is studied, and it is shown that it can be used interchangeably with the frequently used standard glucose oxidase method. Finally, the Dutch law is discussed, and discrepancies between the law and its execution by the Central Vehicle Licensing Agency (CBR) are noted. Recommendations are made for legislators, licensing authorities and medical advisors in the Netherlands and throughout the world to evaluate their legislature, and amend it according to current and emerging insights