Cited by 226Diabetes Management and ResearchTraffic and Road SafetyOlder Adults Driving Studies

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Progressive hypoglycemia’s impact on driving simulation performance: occurrence, awareness and correction

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Cox, D J, Gonder-Frederick, L A, Kovatchev, B P, Julian, D M, Clarke, W L·2000·Diabetes Care

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Abstract

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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Authors: Cox, D. J., Gonder-Frederick, L. A., Kovatchev, B. P., Julian, D. M., & Clarke, W. L.
Affiliations: University of Virginia Health System (US)
ORCID: Cox, D J
Kovatchev, B P
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
DOI: 10.2337/diacare.23.2.163
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

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Progressive hypoglycemia’s impact on driving simulation performance: occurrence, awareness and correction

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