title: Progressive hypoglycemia's impact on driving simulation performance. Occurrence, awareness and correction.
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.
  
  
  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.
authors.affiliation: Behavioral Medicine Center, University of Virginia Health System, Charlottesville 22908, USA. djc4f@virginia.edu
authors.forename: D J
authors.initials: DJ
authors.lastname: Cox
authors.forename: L A
authors.initials: LA
authors.lastname: Gonder-Frederick
authors.forename: B P
authors.initials: BP
authors.lastname: Kovatchev
authors.forename: D M
authors.initials: DM
authors.lastname: Julian
authors.forename: W L
authors.initials: WL
authors.lastname: Clarke
mesh_terms: D000328:Adult; D001334:Automobile Driving; D001364:Awareness; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004569:Electroencephalography; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000503:physiopathology* / Q000523:psychology*; D008297:Male
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin