Glucose Control, Sleep, Obesity, and Real-World Driver Safety at Stop Intersections in Type 1 Diabetes

Background: Diabetes is associated with obesity, poor glucose control and sleep dysfunction which impair cognitive and psychomotor functions, and, in turn, increase driver risk. How this risk plays out in the real-world driving settings is terra incognita. Addressing this knowledge gap requires comprehensive observations of diabetes driver behavior and physiology in challenging settings where crashes are more likely to occur, such as stop-controlled traffic intersections, as in the current study of drivers with Type 1 Diabetes (T1DM). Methods: 32 active drivers from around Omaha, NE participated in 4-week, real-world study. Each participant's own vehicle was instrumented with an advanced telematics and camera system collecting driving sensor data and video. Videos were analyzed using computer vision models detecting traffic elements to identify stop signs. Stop sign detections and driver stopping trajectories were clustered to geolocate and extract driver-visited stop intersections. Driver videos were then annotated to record stopping behavior and key traffic characteristics. Stops were categorized as safe or unsafe based on traffic law. Results: Mixed effects logistic regression models examined how stopping behavior (safe vs. unsafe) in T1DM drivers was affected by 1) abnormal sleep, 2) obesity, and 3) poor glucose control. Model results indicate that one standard deviation increase in BMI (~7 points) in T1DM drivers associated with a 14.96 increase in unsafe stopping odds compared to similar controls. Abnormal sleep and glucose control were not associated with increased unsafe stopping. Conclusion: This study links chronic patterns of abnormal T1DM driver physiology, sleep, and health to driver safety risk at intersections, advancing models to identify real-world safety risk in diabetes drivers for clinical intervention and development of in-vehicle safety assistance technology.