3.2.3 Comorbidities and end-organ complications
Assessment and management of comorbidities is an important aspect of managing people with diabetes with respect to their fitness to drive. This should be part of routine review as per recommended practice7,8 and may include but is not limited to, the following:
- Vision. (Refer to section 10 Vision and eye disorders.) Visual acuity should be tested annually. Retinal screening should be undertaken every second year if there is no retinopathy, or more frequently if at high risk. Visual field testing is not required unless clinically indicated.7,8
- Neuropathy and foot care. While it can be difficult to be prescriptive about neuropathy in the context of driving, it is important that the severity of the condition is assessed. Adequate sensation and movement for the operation of foot controls is required (refer to section 6 Neurological conditions and section 5 Musculoskeletal conditions).
- Sleep apnoea. Sleep apnoea is a common comorbidity affecting many people with type 2 diabetes and has substantial implications for road safety. The treating health professional should be alert to potential signs (e.g. BMI greater than 35) and symptoms, and apply the Epworth Sleepiness Scale as appropriate (refer to section 8 Sleep disorders).
- Cardiovascular. There are no diabetes-specific medical standards for cardiovascular risk factors and driver licensing. Consistent with good medical practice, people with diabetes should have their cardiovascular risk factors periodically assessed and treated as required (refer to section 2 Cardiovascular conditions).