Introduction: Driving requires sustained attention, rapid decision-making, and motor coordination. For people with diabetes using glucose-lowering medications, hypoglycemia can impair these skills and increase crash risk. Continuous glucose monitoring (CGM) provides real-time glucose data and alerts that may enhance safety, yet little is known about how drivers actually use these devices on the road.
Purpose: To examine the relationship between CGM use and self-reported hypoglycemia while driving, and to explore drivers' perceptions of CGM features and barriers to use.
Method: A national cross-sectional online survey was conducted in Australia (June-August 2025). Eligible participants were adults with diabetes treated with glucose-lowering medication and holding a valid driver licence. The survey collected sociodemographic, clinical, and driving data, including hypoglycemia frequency, glucose monitoring methods, CGM usage patterns, and desired features. Logistic regression examined associations between CGM use and hypoglycemia while driving. Open-text responses were analysed for themes.
Results: A total of 1,209 drivers participated (mean age 55 years; 47% CGM users; 36% type 1 diabetes). In the past year, 28% reported at least one hypoglycemia episode while driving. Compared with non-users, CGM users had higher odds of reporting hypoglycemia (adjusted OR 4.22 [95% CI 2.72-6.55]), suggesting greater detection and awareness. Two-thirds relied on vibration or sound alerts, while fewer than one in five adjusted thresholds specifically for driving. The most common barrier was uncertainty about legal use of CGM (43%). Thematic analysis highlighted drivers' calls for in-car integration, clearer voice-based alerts, and legal clarity.
Conclusions: CGM use while driving was associated with increased awareness of hypoglycemia, reflecting improved detection. Drivers expressed a clear need for driving-specific CGM features and legal guidance to support safe, effective use.