Abstract
Adolescent and young adult (AYA) drivers are at high risk for automobile accidents and fatalities (1–3). Unintentional accidents were the leading cause of death in 2017 of individuals aged 15–19 years in the United States (4). Factors that increase driving safety risk associated with AYA drivers include lack of driving experience, developmental factors such as poor executive function, and propensity for risk-taking behaviors (5,6). Furthermore, cognitive abilities such as self-control and emotional regulation are continuing to develop through late adolescence and into young adulthood, making AYA drivers particularly vulnerable to practicing unsafe driving behaviors (7). Brain development—in particular the prefrontal cortex, which relates to impulse control—is known to continue well into young adulthood, not reaching adult dimensions until the mid-20s (8,9). AYAs with type 1 diabetes face a unique set of challenges relating to driving safety. Blood glucose fluctuations leading to hypoglycemia can temporarily impair cognitive function (10–12) and lead to unsafe driving conditions (13). Given the safety risks posed by hypoglycemia, the American Diabetes Association (ADA) has made specific recommendations to promote safe driving for individuals with diabetes (14). The ADA recommends that drivers with type 1 diabetes measure their blood glucose level before driving and at regular intervals if they are driving for longer than 1 hour. Individuals with type 1 diabetes should be counseled to always carry appropriate rapid-acting glucose and complex micronutrient snacks. If symptoms of hypoglycemia occur, individuals should immediately stop driving, check their blood glucose, and treat low blood glucose levels. Additionally, driving should only be resumed after achievement of euglycemia and once cognitive functioning has been recovered (i.e., ideally 30–60 minutes after euglycemia is achieved because of concern about delayed cognitive function recovery) (14). Parents of adolescents with type 1 diabetes report that their …
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