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

Abstract

Postbariatric hypoglycemia (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 (8 females, age 38.2 ± 14.7 years, BMI 27.2 ± 4.6 kg/m2) received 75 g glucose to induce PBH in the late postprandial period and aspartame to leave glycemia unchanged, on two different occasions. A simulator was driven during 10 min before (D0) and 20 (D1), 80 (D2), 125 (D3) and 140 min (D4) after the glucose/aspartame ingestion, reflecting the expected blood glucose (BG) increase (D1), decrease (D2), and hypoglycemia (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 vs. aspartame during D4 (posterior probability 98.2%). Our findings suggest that PBH negatively affects driving performance.