What are the guidelines for managing patients with diabetes in relation to their driving privileges?

Clinical guidelines for managing patients with diabetes in relation to their driving privileges focus on ensuring safe blood glucose control to prevent hypoglycaemia while driving.

Adults with type 1 diabetes should be advised to self-monitor their blood glucose levels at least 4 times a day, including before driving, to reduce the risk of hypoglycaemia while driving. More frequent monitoring (up to 10 times a day or more) is recommended if they have impaired hypoglycaemia awareness, undertake high-risk activities such as driving for long periods, or have a high-risk occupation. This includes measuring blood glucose before, during, and after driving if necessary. Support and education should be provided to improve the use of continuous glucose monitoring (CGM) devices if used, to enhance safety during driving.

For adults with type 2 diabetes, self-monitoring of blood glucose is not routinely recommended unless they are on insulin, have evidence of hypoglycaemia, are on oral medication that increases hypoglycaemia risk, or are pregnant/planning pregnancy. The Driver and Vehicle Licensing Agency (DVLA) guidelines should be taken into account when advising on self-monitoring and fitness to drive. Structured assessment of blood glucose control and hypoglycaemia risk should be conducted at least annually for those self-monitoring.

In all cases, patients should be supported to achieve blood glucose targets that minimise hypoglycaemia risk, and healthcare professionals should consider individual factors such as impaired hypoglycaemia awareness and the nature of the patient’s driving or occupational risks when advising on driving safety.

Healthcare professionals should refer to the DVLA's "Assessing fitness to drive: a guide for medical professionals" for detailed legal and clinical requirements related to diabetes and driving.

Summary:

• Type 1 diabetes: frequent blood glucose monitoring (≥4 times/day), especially before driving; consider more frequent checks if impaired awareness or high-risk activities (including driving) ¹.
• Type 2 diabetes: self-monitoring advised if on insulin, hypoglycaemia risk, or pregnancy; consider DVLA guidance ².
• Use of CGM devices should be supported and optimised to improve safety ¹.
• Annual structured assessment of blood glucose control and hypoglycaemia risk for those self-monitoring ².
• Refer to DVLA guidance for legal fitness to drive assessments ².