How diabetes can affect your ability to control the pedals while driving

Imagine a driver taking a sharp turn on a rural road. As the vehicle navigates the corner, they adjust the foot on the pedals. However, in some cases, a diabetic driver might inadvertently press the accelerator instead of the brake. This scenario could be attributed to a condition called diabetic peripheral neuropathy, a form of nerve damage linked to diabetes.

This study examined 44 licensed drivers using a driving simulator, with 15 participants having diabetic peripheral neuropathy. During challenging sections of the simulated route, only those with neuropathy made a specific error: pressing the accelerator when braking was required. No drivers without nerve damage made this mistake.

The study reveals that nerve damage due to diabetes can contribute to pedal confusion while driving. Diabetic peripheral neuropathy, one of diabetes' most common long-term complications, affects about half of people with the condition. It damages peripheral nerves, particularly those in the feet and lower legs, often causing numbness, tingling, or pain.

Up to half of those with neuropathy may not exhibit obvious symptoms, leading to potential unawareness of nerve damage. The research builds on previous findings that drivers with neuropathy use the accelerator differently, spending more time in extreme positions and having impaired ankle proprioception. Proprioception is the body's sense of its parts' position, allowing individuals to know roughly where their foot is without looking.

In another study, drivers with neuropathy demonstrated impaired coordination of eye movements and steering, which, when improved, reduced control loss during driving. These findings may explain the causes of pedal errors. When nerves carrying information from the foot and ankle are damaged, the brain receives less reliable information about foot position and movement.

This could make it difficult for someone to determine which pedal their foot is pressing during rapid maneuvers. Some participants with neuropathy looked down at their feet while driving, likely using vision to confirm foot position. Unlike drivers without neuropathy, they did not perform this action. This has implications beyond the laboratory, as diabetic nerve damage is prevalent and may develop without noticeable symptoms.

Diabetic nerve damage's prevalence is particularly important among people who drive for work. A 2025 Diabetes Safety Organization report estimates that one in six commercial drivers has diabetes, with a 2024 survey suggesting that up to two in five employees in the road transport sector may have the condition. UK driving rules already acknowledge that peripheral neuropathy can affect driving, with the DVLA guidance recommending reporting neuropathy and its medical guidance acknowledging that neuropathy affecting limb function may necessitate changes like vehicle adaptations.

However, current guidance does not include routine driving assessments of the potential loss of foot and ankle position sense. People with diabetes should receive regular foot examinations as part of their care. One possibility to reduce the consequences of pedal errors is the implementation of acceleration limiters, which restrict how strongly a vehicle accelerates when the pedal is pressed.

Improved footwell lighting for drivers who rely on vision to check their feet' position could also be beneficial. Another option is using a manual car instead of an automatic one, as the gear selection in a manual vehicle limits how the car responds to the accelerator. However, these measures need further testing before being recommended as safety interventions.

The next step is to connect what is known about diabetic foot sensation with driving demands. Identifying this problem before a dangerous pedal error occurs could help protect the driver and others on the road.