Diabetes mellitus and hard braking events in older adult drivers

Liu, Difei; Chihuri, Stanford; Andrews, Howard; Betz, Marian E.; DiGuiseppi, Carolyn; Eby, David W.; Hill, Linda L.; Jones, Vanya; Mielenz, Thelma J.; Molnar, Lisa J.; Strogatz, David; Lang, Barbara H.; Li, Guohua · 2024 · Injury Epidemiology

DOI: 10.1186/s40621-024-00508-2

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Summary

This study investigates the association between diabetes mellitus (DM) and driving safety among older adults, specifically examining whether DM status and insulin use correlate with hard braking events (HBEs). The research addresses a gap in existing literature, as few studies have utilized naturalistic driving data to assess this relationship in older populations. Given that DM can impair driving through hypoglycemia, hyperglycemia, neuropathy, and eye disease, and that older adults rely heavily on driving for mobility, understanding these risks is critical for public health and clinical management. The researchers analyzed data from the Longitudinal Research on Aging Drivers (LongROAD) project, a multisite naturalistic driving study. The cohort consisted of 2,856 active drivers aged 65–79 years at baseline, recruited from five US sites between 2015 and 2017. Participants were monitored for up to 44 months using in-vehicle recording devices that captured driving exposure and maneuvers. DM status was determined via self-report and medication review, categorizing participants into those without DM, those with DM not using insulin, and those with DM using insulin. The primary outcome was the incidence of HBEs, defined as maneuvers with deceleration rates ≥ 0.4 g, which serve as a proxy for near-crashes. Multivariable negative binomial modeling was employed to estimate adjusted incidence rate ratios (aIRRs), controlling for demographic factors, socioeconomic status, urbanicity, and polypharmacy. The results indicated that 16.9% of participants had DM at baseline, with 4.5% using insulin. The overall incidence rate of HBEs was 1.16 per 1,000 miles. Drivers without DM had an incidence rate of 1.13 per 1,000 miles, while those with DM not using insulin had a similar rate of 1.15. In contrast, drivers with DM using insulin exhibited a significantly higher incidence rate of 1.77 per 1,000 miles. After adjusting for covariates, DM without insulin use was associated with a slightly decreased risk of HBEs (aIRR 0.97; 95% CI: 0.95, 0.99). However, DM with insulin use was associated with a 48% increased risk of HBEs (aIRR 1.48; 95% CI: 1.43, 1.53) compared to drivers without DM. The study concludes that older adult drivers with DM who use insulin are at a significantly increased risk of hard braking events, suggesting a higher proneness to vehicular crashes. This risk is not observed in older drivers with DM who do not use insulin. The findings imply that driving safety should be integrated into diabetes care and management programs for older adults, particularly for those on insulin therapy. The authors suggest that the increased risk among insulin users may be partly explained by a higher susceptibility to hypoglycemia in older populations. Future research is recommended to explore the specific mechanisms linking DM complications and treatment to crash risk.

Key finding

Older adult drivers with diabetes mellitus who use insulin have a 48% higher risk of hard braking events compared to drivers without diabetes.

Methodology

naturalistic

Sample size: 2856

Provenance

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Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.

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• medical conditions