Type 1 Diabetic Drivers With and Without a History of Recurrent Hypoglycemia–Related Driving Mishaps

Physiological and performance differences during euglycemia and the induction of hypoglycemia

  1. Linda A. Gonder-Frederick, PHD1
  1. 1Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health Sciences Center, Charlottesville, Virginia;
  2. 2Department of Medicine, University of Virginia Health Sciences Center, Charlottesville, Virginia;
  3. 3Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville, Virginia.
  1. Corresponding author: Daniel J. Cox, djc4f{at}virginia.edu.

Abstract

OBJECTIVE Collisions are more common among drivers with type 1 diabetes than among their nondiabetic spouses. This increased risk appears to be attributable to a subgroup of drivers with type 1 diabetes. The hypothesis tested is that this vulnerable subgroup is more at risk for hypoglycemia and its disruptive effects on driving.

RESEARCH DESIGN AND METHODS Thirty-eight drivers with type 1 diabetes, 16 with (+history) and 22 without (−history) a recent history of recurrent hypoglycemia-related driving mishaps, drove a virtual reality driving simulator and watched a videotape of someone driving a simulator for 30-min periods. Driving and video testing occurred in a double-blind, randomized, crossover manner during euglycemia (5.5 mmol/l) and progressive hypoglycemia (3.9–2.5 mmol/l). Examiners were blind to which subjects were +/−history, whereas subjects were blind to their blood glucose levels and targets.

RESULTS During euglycemia, +history participants reported more autonomic and neuroglycopenic symptoms (P ≤ 0.01) and tended to require more dextrose infusion to maintain euglycemia with the same insulin infusion (P < 0.09). During progressive hypoglycemia, these subjects demonstrated less epinephrine release (P = 0.02) and greater driving impairments (P = 0.03).

CONCLUSIONS Findings support the speculation that there is a subgroup of type 1 diabetic drivers more vulnerable to experiencing hypoglycemia-related driving mishaps. This increased vulnerability may be due to more symptom “noise” (more symptoms during euglycemia), making it harder to detect hypoglycemia while driving; possibly greater carbohydrate utilization, rendering them more vulnerable to experiencing hypoglycemia; less hormonal counterregulation, leading to more profound hypoglycemia; and more neuroglycopenia, rendering them more vulnerable to impaired driving.

Footnotes

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  • Received November 19, 2009.
  • Accepted August 3, 2010.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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  1. Diabetes Care vol. 33 no. 11 2430-2435
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