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Progressive hypoglycemia’s impact on driving simulation performance: occurrence, awareness and correction
Open accessAbstract
OBJECTIVE: Progressive hypoglycemia leads to cognitive-motor and driving impairments. This study evaluated the blood glucose (BG) levels at which driving was impaired, impairment was detected, and corrective action was taken by subjects, along with the mechanisms underlying these three issues. RESEARCH DESIGN AND METHODS: There were 37 adults with type 1 diabetes who drove a simulator during continuous euglycemia and progressive hypoglycemia. During testing, driving performance, EEG, and corrective behaviors (drinking a soda or discontinuing driving) were continually monitored, and BG, symptom perception, and judgement concerning impairment were assessed every 5 min. Mean +/- SD euglycemia performance was used to quantify z scores for performance in three hypoglycemic ranges (4.0-3.4, 3.3-2.8, and <2.8 mmol/l). RESULTS: During all three hypoglycemic BG ranges, driving was significantly impaired, and subjects were aware of their impaired driving. However, corrective actions did not occur until BG was <2.8 mmol/l. Driving impairment was related to increased neurogenic symptoms and increased theta-wave activity. Awareness of impaired driving was associated with neuroglycopenic symptoms. increased beta-wave activity, and awareness of hypoglycemia. High beta and low theta activity and awareness of both hypoglycemia and the need to treat low BG influenced corrective behavior. CONCLUSIONS: Driving performance is significantly disrupted at relatively mild hypoglycemia, yet subjects demonstrated a hesitation to take corrective action. The longer treatment is delayed, the greater the neuroglycopenia (increased theta), which precludes corrective behaviors. Patients should treat themselves while driving as soon as low BG and/or impaired driving is suspected and should not begin driving when their BG is in the 5.0-4.0 mmol/l range without prophylactic treatment.
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“Hypoglycemia also impairs one’s ability to drive a car (89–91), and many jurisdictions require documentation that severe hypoglycemia is not occurring before persons with diabetes are permitted to have a license to operate a motor vehicle (92).”
From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [90]
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“Hypoglycemia also impairs one ' s ability to drive a car (89 -91), and many jurisdictions require documentation that severe hypoglycemia is not occurring before persons with diabetes are permitted to have a license to operate a motor vehicle (92).”
From Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society (2013) · cites this paper as [90]
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Metadata
- Authors
- Cox, D. J., Gonder-Frederick, L. A., Kovatchev, B. P., Julian, D. M., & Clarke, W. L.
- Affiliations
- University of Virginia Health System (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2000-02-01
- Volume
- 23
- Issue
- 2
- Pages
- 163-170
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2166677825
- Cited by
- 226
- References
- 0
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 5 · 2023: 8 · 2022: 6 · 2021: 7 · 2020: 8 · 2019: 8 · 2018: 7 · 2017: 4 · 2016: 16 · 2015: 13 · 2014: 7 · 2013: 15 · 2012: 12
- FWCI
- 7.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk028288-27)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-28288)
- National Center for Research Resources (RR 00847, M01RR000847)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Physical Sciences › Engineering › Safety, Risk, Reliability and Quality › Traffic and Road Safety
- Health Sciences › Medicine › Geriatrics and Gerontology › Older Adults Driving Studies
- Keywords
- hypoglycemia, driving impairment, type 1 diabetes, blood glucose, driving simulator, hypoglycemia awareness, neuroglycopenia, EEG theta activity, beta activity, hypoglycemic treatment
- MeSH terms
- Adult, Automobile Driving, Awareness, Blood Glucose, Diabetes Mellitus, Type 1, Electroencephalography, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Male
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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