Driving-Related Glucose Patterns Among Older Adults with Type 1 Diabetes

Area of Science:

• Gerontology
• Endocrinology
• Diabetes Management

Background:

• Older adults with type 1 diabetes (T1D) face unique challenges in maintaining driving safety.
• Hypoglycemia during driving poses a significant risk, leading to the
• above-5-to-drive
• guideline for insulin-treated individuals.
• The efficacy of this guideline in older adults with T1D has not been previously evaluated.

Purpose of the Study:

• To evaluate the effectiveness of the
• above-5-to-drive
• glucose recommendation for older adults with T1D.
• To assess the incidence of hypoglycemia during driving in this population.
• To investigate the role of continuous glucose monitoring (CGM) alerts in preventing driving-related hypoglycemia.

Main Methods:

• A 2-week clinical trial run-in assessed 23 older drivers with T1D (median age 69 years) using sensor-augmented insulin pumps.
• Data collected included 618 driving trips with pre-trip and in-trip continuous glucose monitoring (CGM) data.
• Analysis focused on pre-trip glucose levels, in-trip glucose fluctuations, and CGM alert occurrences.

Main Results:

• 93% of trips (577/618) started with pre-trip CGM >5.0 mmol/L, and none experienced CGM <3.9 mmol/L during driving.
• Even for trips exceeding 90 minutes (8 trips) or 120 minutes (3 trips), no hypoglycemia was detected when starting with glucose >5.0 mmol/L.
• However, 11 out of 41 trips (27%) starting with pre-trip CGM ≤5.0 mmol/L resulted in hypoglycemia (<3.9 mmol/L).
• CGM alerts occurred in 10% of trips, with 76% unrelated to hypoglycemia.

Conclusions:

• The
• above-5-to-drive
• recommendation is supported for older drivers with T1D to prevent CGM-detected hypoglycemia.
• This guideline is effective even for prolonged driving durations.
• Active CGM low-glucose alerts are crucial for preventing hypoglycemia during driving, and their usability warrants further investigation.