Fear of driving license withdrawal in patients with insulin-treated diabetes mellitus negatively influences their decision to report severe hypoglycemic events to physicians

Jan Brož,1 Marek Brabec,2,3 Denisa Janíčková Žďárská,1 Zuzana Fedáková,1 Lucie Hoskovcová,1 Jee Young You,4 Viera Doničová,5 Petr Hlaďo,6 Dario Rahelić,7 Milan Kvapil,1 Jan Polák8 1Department of Internal Medicine, Second Faculty of Medicine, Charles University, 2Institute of Computer Science of the Academy of Sciences of the Czech Republic, 3Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, 4Second Faculty of Medicine, Charles University, Prague, Czech Republic; 5Diabetes and Metabolism Center, Juh Polyclinic, Kosice, Slovakia; 6Institute of Lifelong Learning, Mendel University in Brno, Brno, Czech Republic; 7Department of Endocrinology, Diabetes and Metabolic Diseases, Dubrava University Hospital, Zagreb, Croatia; 8Center for Research on Diabetes, Metabolism and Nutrition, Second Department of Internal Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic Background: Under current European Union legislation, two severe hypoglycemic events within 12 months is grounds for driving license withdrawal. The aim of the study reported here was to determine whether fear of such a withdrawal could lead to patients concealing severe hypoglycemia from physicians, which could negatively impact further treatment decisions.Methods: A total of 663 patients with insulin-treated diabetes were anonymously surveyed about whether they would conceal severe hypoglycemic events from their physicians, if revealing them could result in driving license withdrawal. This investigation utilized an adapted and expanded questionnaire by Graveling et al. Results: Of all diabetic patients surveyed, 26.17% would most likely not report hypoglycemia, and 25.86% were undecided. In a group of patients with type 1 diabetes, 31.83% would likely not report hypoglycemic events, and 25.06% were undecided. The patients least likely to report severe hypoglycemic events were those who indicated that vehicles were partly essential for work, and who also had more than two hypoglycemic events monthly. Conclusion: A considerable percentage of diabetic patients would likely conceal severe hypoglycemic events from their physicians due to fear of driving license withdrawal. Patient failure to report severe hypoglycemic events can potentially lead to physicians being misinformed regarding the patient’s condition, which could lead to inadequate monitoring and treatment. Keywords: hypoglycemia, education, law, type 1 diabete