Could FreeStyle Libre™ sensor glucose data support decisions for safe driving?

G Rayman, J Kröger, J Bolinder, G Rayman, J Kröger, J Bolinder

Abstract

Aim: Many countries require individuals with diabetes to adhere to standards regarding blood glucose testing in order to be granted or retain a driving licence. Currently, interstitial glucose results may not be used. The aim of this study was to determine whether interstitial glucose measurements using flash glucose-sensing technology can provide additional information to augment safe driving.

Methods: Sensor data from two European studies (NCT02232698 and NCT02082184) of the FreeStyle Libre Glucose Monitoring System™ in insulin-treated Type 1 and Type 2 diabetes, 241 and 224 participants respectively, were used to determine the frequency of a low interstitial sensor glucose result (< 3.9 mmol/l) up to 4 h subsequent to a daytime (07:00-21:00 h) capillary blood glucose result ≥ 5 mmol/l.

Results: Within 4 h of a capillary blood glucose result ≥ 5 mmol/l a sensor glucose result of < 3.9 mmol/l occurred on 22.0% of occasions (2573 of 11 706 blood glucose readings) for those with Type 1 diabetes, and 8.4% of occasions (699/8352) for those with Type 2 diabetes; 13.8% (1610/11 628) and 4.4% (365/8203) within 2 h, and 10.0% (1160/11 601) and 3.1% (254/8152) within 1.5 h. Analysis of sensor glucose results 5-7 mmol/l demonstrated the glucose trend arrow descending on 14.7% (1163/7894, Type 1 diabetes) and 9.4% (305/3233, Type 2 diabetes) of occasions.

Conclusions: Sensor-based glucose information with directional arrows has the potential to support assessment of safe glucose levels associated with driving and offers distinct advantages over blood glucose testing for individuals with Type 1 and Type 2 diabetes to concord with driving safety standards.

© 2017 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Figures

Figure 1
Figure 1
Example of daytime masked sensor glucose data and blood glucose (BG) results. Green shading signifies no sensor glucose results < 3.9 mmol/l in the 2 h after the BG reading ≥ 5 mmol/l. Red shading signifies at least one sensor glucose result < 3.9 mmol/l in the 2 h after the BG reading ≥ 5 mmol/l.

References

    1. Driver and Vehicle Licensing Agency (DVLA) . Assessing fitness to drive – a guide for medical professionals 2017. Available at Last accessed 5 April 2017.
    1. Min T, Dixon AN. Driving and insulin‐treated diabetes. J Diabetes Nurs 2015; 19: 255–259.
    1. Pedersen‐Bjergaard U, Faerch L, Allingbjerg ML, Agesen R, Thorsteinsson B. The influence of New European Union driver's license legislation on reporting of severe hypoglycaemia by patients with Type 1 diabetes. Diabetes Care 2015; 38: 29–33.
    1. Graveling AJ, Frier BM. Driving and diabetes: problems, licensing restrictions and recommendations for safe driving. Clin Diabetes Endocrinol 2015; 1–8. Available at Last accessed 23 June 2017.
    1. Watson WA, Currie T, Lemon JS, Gold AE. Driving and insulin treated diabetes: who knows the rules and recommendations? Pract Diabetes 2007; 24: 201–206.
    1. Graveling AJ, Warren RE, Frier BM. Hypoglycaemia and driving in people with insulin treated diabetes: adherence to recommendations for avoidance. Diabet Med 2004; 21: 1014–1019.
    1. Gallen I, Amiel S, Robinson T. McKnight J, on behalf of the ABCD Committee. Driving and hypoglycaemia: questions and answers. Pract Diabetes 2012; 29: 13–14.
    1. Diabetes and Driving in Europe: A report of the second European working group on diabetes and driving, an advisory board to the Driving Licence Committee of the European Union , 2006. Available at Last accessed 5 April 2017.
    1. Bailey T, Bode BW, Christiansen MP, Klaff LJ, Alva S. The performance and usability of a factory‐calibrated flash glucose monitoring system. Diabetes Technol Ther 2015; 17: 787–794.
    1. Bolinder J, Antuna R, Geelhoed P, Kroeger J, Weitgasser R. Using novel flash glucose‐sensing technology reduces hypoglycemia in individuals with Type 1 diabetes. Lancet 2016; 388: 2254–2263.
    1. Haak T, Hanaire H, Ajjan RA, Hermanns N, Riveline J‐P, Rayman G. Flash glucose‐sensing technology as a replacement for blood glucose monitoring for the management of insulin‐treated type 2 diabetes: a multicenter, open‐label randomized controlled trial. Diabetes Ther 2017; 8: 55–73.
    1. Cameron D, Harris FM, Evans JMM. Patterns of self‐monitoring of blood glucose (SMBG) in insulin treated diabetes: analysis of a Scottish population over time. Diabetes Obes Metab 2016; 18: 729–731.
    1. Inkster B, Pooley D, De Saxe H, Ahraf M, Frier B. Blood glucose testing by drivers with diabetes: a survey of glucose meter users. Br J Diabetes, Vasc Dis 2015; 15: 20–23.
    1. Bell D, Huddart A, Krebs J. Driving and insulin treated diabetes: comparing practices in Scotland and New Zealand. Diabet Med 2010; 27: 1093–1095.
    1. Jackson‐Koku G, Morrison G, Morrison CL, Weston PJ. Insulin‐treated diabetes and driving: what is the patient's knowledge of current regulations? Br J Diabetes Vasc Dis 2010; 10: 31–34.

Source: PubMed

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