Neurocognitive differences between drivers with type 1 diabetes with and without a recent history of recurrent driving mishaps

OBJECTIVE: A subset of drivers with type 1 diabetes mellitus (T1DM) may be at significant risk of hypoglycemia-related driving collisions and moving vehicle violations due to acute and chronic neurocognitive impairment. The present study compared drivers with T1DM with and without a recent history of multiple driving mishaps on a neurocognitive battery during euglycemia, progressive mild hypoglycemia, and recovery from hypoglycemia, to determine whether neurocognitive measures differentiate the two risk groups. We hypothesized that drivers with a history of multiple recent hypoglycemia-related driving mishaps would demonstrate greater psychomotor slowing, both during hypoglycemia and euglycemia. STUDY DESIGN: Partcipants were 42 adults with T1DM and were assigned to one of two groups: those reporting no driving mishaps in the last year (-History) and those reporting two or more (+History).Neurocognitive testing was conducted before and repeated during a hyper-insulinemic clamping procedure. RESULTS: Not surprisingly, all drivers demonstrated a decrease in functioning across all neurocognitive tasks during hypoglycemia. However, in contrast to the common belief that neurocognitive functions return slowly and gradually following hypoglycemia, baseline neurocognitive functioning immediately recovered upon return of BG to euglycemia for all subjects. Between-group analyses revealed that subjects with a recent history of driving mishaps consistently demonstrated poorer performance on tasks measuring working memory. CONCLUSION: Working memory is a potential neurocognitive indicator that may help differentiate adults with T1DM with and without a history of driving mishaps, predict future risk for driving mishaps, and provide targeted intervention programs to address this critical public health issue.