The impact of postbariatric hypoglycaemia on driving performance: A randomized, single‐blind, two‐period, crossover study in a driving simulator

Abstract

Postbariatric hypoglycaemia (PBH) is an increasingly recognized complication of bariatric surgery, but its effect on daily functioning remains unclear. In this randomized, single‐blind, crossover trial we assessed driving performance in patients with PBH. Ten active drivers with PBH (eight females, age 38.2 ± 14.7 years, body mass index 27.2 ± 4.6 kg/m2) received 75 g glucose to induce PBH in the late postprandial period and aspartame to leave glycaemia unchanged, on two different occasions. A simulator was driven during 10 minutes before (D0) and 20 (D1), 80 (D2), 125 (D3) and 140 minutes (D4) after the glucose/aspartame ingestion, reflecting the expected blood glucose (BG) increase (D1), decrease (D2) and hypoglycaemia (D3, D4). Seven driving features indicating impaired driving were integrated in a Bayesian hierarchical regression model to assess the difference in driving performance after glucose/aspartame ingestion. Mean ± standard deviation peak and nadir BG after glucose were 182 ± 24 and 47 ± 14 mg/dL, while BG was stable after aspartame (85 ± 4 mg/dL). Despite the lack of a difference in symptom perception, driving performance was significantly impaired after glucose versus aspartame during D4 (posterior probability 98.2%). Our findings suggest that PBH negatively affects driving performance.

Leveraging driver vehicle and environment interaction: Machine learning using driver monitoring cameras to detect drunk driving

“…The driving tasks were conducted in a driving simulator (Carnetsoft BV, Groningen, The Netherlands). The simulator offers a realistic setting and is widely used in medical research [49,97]. The simulator consists of three screens with a field-of-view of 270 degrees, a steering wheel, and pedals for an immersive driver experience.…”

Forecasting postbariatric hypoglycaemia in patients after Roux‐en‐Y gastric bypass using model‐based algorithms fed by continuous glucose monitoring data: A proof‐of‐concept study

“…CGM can be leveraged to develop RT predictive algorithms allowing for preventive or timely corrective actions (e.g. carbohydrate intake), which may be particularly useful for the frequently encountered patients with PBH with hypoglycaemia unawareness and related safety concerns 7,8 …”

“…carbohydrate intake), which may be particularly useful for the frequently encountered patients with PBH with hypoglycaemia unawareness and related safety concerns. 7,8 While hypoglycaemia forecasting has been widely studied in type 1 diabetes (T1D), 9 the topic remains understudied in the PBH population. The first and only contribution in this field was the development of a heuristic-based predictive algorithm for a glucose-responsive glucagon delivery system in an experimental inpatient session.…”

Medical and surgical treatment of postbariatric hypoglycaemia: Retrospective data from daily practice

“…Most bariatric patients experience some degree of postprandial low blood sugar, usually 1‐2 h after a meal, which is probably a physiological consequence of the changes induced by the surgery. There is, however, a small number of patients who experience a low blood sugar with severe neuroglycopenic symptoms, which interfere with daily life, sometimes even leading to accidents and hospital admissions 2,3 …”

“…There is, however, a small number of patients who experience a low blood sugar with severe neuroglycopenic symptoms, which interfere with daily life, sometimes even leading to accidents and hospital admissions. 2,3 First-line treatment of PBH is dietary advice consisting of frequent small, carbohydrate-low and protein-rich meals reducing the hyperglycaemic excursion shortly after a meal.…”