Altered accelerator pedal control in a driving simulator in people with diabetic peripheral neuropathy. Issue 2 (6th May 2019) - Perazzolo, M.
Abstract: Aim: To investigate whether the sensory‐motor impairment attributable to diabetic peripheral neuropathy would affect control of the accelerator pedal during a driving simulator task. Methods: A total of 32 active drivers, 11 with diabetic peripheral neuropathy (mean ± sd age 67±5.0 years), 10 with diabetes but no neuropathy (diabetes group; mean ± sd age 62±10 years), and 11 healthy individuals without diabetes (healthy group; mean ± sd age 60±11 years), undertook a test on a dynamometer to assess ankle plantar flexor muscle strength and ankle joint proprioception function of the right leg, in addition to a driving simulator task. The following variables were measured: maximal ankle plantar flexor muscle strength; speed of strength generation (Nm/s); and ankle joint proprioception (ankle repositioning error, degrees). In the driving simulator task, driving speed (mph), accelerator pedal signal (degrees) and the duration of specific 'loss‐of‐control events' (s) were measured during two drives (Drive 1, Drive 2). Results: Participants with diabetic peripheral neuropathy had a lower speed of strength generation ( P <0.001), lower maximal ankle plantar flexor muscle strength ( P <0.001) and impaired ankle proprioception ( P =0.034) compared to healthy participants. The diabetic peripheral neuropathy group drove more slowly compared with the healthy group (Drive 1 P =0.048; Drive 2 P =0.042) and showed marked differences in the use of the accelerator pedal compared to both the diabetes group ( P =0.010) and the healthy group ( P =0.002). Participants with diabetic peripheral neuropathy had the longest duration of loss‐of‐control events, but after one drive, this was greatly reduced ( P =0.023). Conclusions: Muscle function, ankle proprioception and accelerator pedal control are all affected in people with diabetic peripheral neuropathy, adversely influencing driving performance, but potential for improvement with targeted practice remains possible. What's new?: Diabetes impacts driving safety through the influence of hypoglycaemia and diabetic retinopathy. Diabetic peripheral neuropathy (DPN) affects tactile sensation, proprioception and muscle strength primarily in the feet and the lower limbs. Drivers with DPN showed reduced ankle position sense, impaired muscle function and an altered use of the accelerator pedal. Despite driving more slowly, drivers with DPN experienced more loss‐of‐control events than other drivers, but demonstrated a residual ability to improve with practice. Control of the accelerator pedal and overall driving performance are affected by DPN, but this research opens up opportunities to devise technological solutions and training programmes to help people with DPN drive more safely.