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Objectives: Insulin-treated patients with diabetes are at a higher risk than the general population in causing traffic accidents due to hypoglycaemias. Preceding investigations focused on insulin-treated patients and hypoglycaemia-induced accidents as "end-points". We studied the incidence of symptomatic hypoglycaemia and hypoglycaemia-induced accidents during driving and put it in relation to the different treatment modes of insulin therapy (Conventional Insulin Treatment = CT, Intensified Conventional Insulin Treatment = ICT, Continuous Subcutaneous Insulin Infusion = CSII) as well as to patients treated with oral hypoglycaemia-inducing agents and the two main types of diabetes mellitus.Design: Subjects and Setting: We investigated 450 patients (122 treated with sulphonylureas, 151 with CT, 143 with ICT and 34 with CSII) by an anonymous questionnaire at different locations to avoid bias. A total of 176 persons had type 1 diabetes, 243 persons had type 2 diabetes, 31 subjects could not be classified.Results: Symptomatic hypoglycaemias during driving were rare events with an occurrence of 0.19-8.26 (minimal and maximal mean, depending on the mode of treatment), if given as hypoglycaemias per 100 000 km on one treatment regimen, or 0.02-0.63, if given as events per year driven. Their incidence increased significantly with the degree of "strictness" between the treatment groups, except between the patients treated with ICT and CSII. Hypoglycaemia-induced accidents are rare with 0.01-0.49, if given as events per 100 000 km and 0.007-0.01, if given as events per year driven. These differences were not significant. Significant confounders influencing the traffic safety of the patients were age, duration of diabetes and concomitant antihypertensive medication. Analysing the data in accordance with the type of diabetes revealed a significantly higher rate of hypoglycaemic events in patients with type 1 diabetes. The number of hypoglycaemia-induced accidents was considerably higher in this group, but failed slightly to reach statistical significance.Conclusions: Hypoglycaemias during driving are rare events, their occurrence is significantly influenced by the treatment regimen and type of diabetes. Hypoglycaemia-induced accidents are extremely rare, presumably as a positive effect of patient education in our group. [ABSTRACT FROM AUTHOR]

Thirty-five diabetic patients (mean age 60) underwent regularly controlled treatment for an average of 7 months with 2 1/2 to 20 mg of glipizide daily, the mean dose being almost 10 mg/daily. These patients had been diabetics for an average of 9 years, most had been previously treated with other sulphonamides, one third were obese and 90% had degenerative complications and/or an associated disease. Results showed a 23% mean decrease in mean blood sugar levels and a 21% decrease in maximal blood sugar levels during the day. There was an increase in the number of well or very well controlled patients and a decrease of non-satisfactory results. Renal, hepatic and haematologic monitoring reveared no abnormalities. Minor hypoglycaemic manifestations were not uncommon. Two severe hypoglycaemic attacks occurred in older patients with renal insufficiency associated with hepatic dysfunction. Glipizide is contra-indicated when kidney function is reduced by more than 3/4 and additional caution seems to be necessary in the event of associated hepatic damage. The drug appears to enhance the antiprothrombin action of anticoagulants. [ABSTRACT FROM AUTHOR]