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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.

Cox DJ, Kovatchev BP, Anderson SM, Clarke WL, Gonder-Frederick LA - Diabetes Care (2010)

Bottom Line: The hypothesis tested is that this vulnerable subgroup is more at risk for hypoglycemia and its disruptive effects on driving.During progressive hypoglycemia, these subjects demonstrated less epinephrine release (P=0.02) and greater driving impairments (P=0.03).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health SciencesCenter, Charlottesville, Virginia, USA. djc4f@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.

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Related in: MedlinePlus

IDS during euglycemic and hypoglycemic conditions for +/−history subjects. ■, +history; ▤, −history.
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Figure 2: IDS during euglycemic and hypoglycemic conditions for +/−history subjects. ■, +history; ▤, −history.

Mentions: Although +history subjects drove just as well as −history subjects during euglycemia, they demonstrated a marked impairment in performance during progressive hypoglycemia (group × condition F = 5.0, P = 0.03). As illustrated in Fig. 2, +history subjects' driving performance worsened almost 2.5 SDs from euglycemia to hypoglycemia, whereas −history subjects demonstrated no driving impairment, driving slightly (but not significantly) better during hypoglycemia.


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.

Cox DJ, Kovatchev BP, Anderson SM, Clarke WL, Gonder-Frederick LA - Diabetes Care (2010)

IDS during euglycemic and hypoglycemic conditions for +/−history subjects. ■, +history; ▤, −history.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2963507&req=5

Figure 2: IDS during euglycemic and hypoglycemic conditions for +/−history subjects. ■, +history; ▤, −history.
Mentions: Although +history subjects drove just as well as −history subjects during euglycemia, they demonstrated a marked impairment in performance during progressive hypoglycemia (group × condition F = 5.0, P = 0.03). As illustrated in Fig. 2, +history subjects' driving performance worsened almost 2.5 SDs from euglycemia to hypoglycemia, whereas −history subjects demonstrated no driving impairment, driving slightly (but not significantly) better during hypoglycemia.

Bottom Line: The hypothesis tested is that this vulnerable subgroup is more at risk for hypoglycemia and its disruptive effects on driving.During progressive hypoglycemia, these subjects demonstrated less epinephrine release (P=0.02) and greater driving impairments (P=0.03).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health SciencesCenter, Charlottesville, Virginia, USA. djc4f@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.

Show MeSH
Related in: MedlinePlus