Diabetes-Related Nerve Damage May Impair Pedal Control in Driving, Study Finds

The Conversation reports on a driving-simulator study investigating how diabetes related nerve damage in the feet affects pedal control. Forty four licensed drivers were studied, including 15 with diabetic peripheral neuropathy and 29 without. When navigating demanding route sections, neuropathy participants more often pressed the accelerator instead of the brake, a pedal error not observed in drivers without nerve damage. The findings suggest that loss of foot sensation can contribute to pedal confusion, with implications for driving safety and routine diabetes foot examinations. The article discusses possible safety measures such as acceleration limiters and better footwell lighting, and notes the need for proper testing before any recommendations. The Conversation presents the study and its interpretation.

• Diabetes related nerve damage can affect foot sense
• Pedal errors occurred mainly in neuropathy group
• Foot examinations and driving safety policies may need attention
• Potential interventions require careful testing

Overview

A new study published in The Conversation uses a driving simulator to explore how diabetic peripheral neuropathy, a common chronic complication of diabetes, can influence foot position sense and driving behavior. The research involved 44 licensed drivers, of whom 15 had diabetic nerve damage affecting the feet. The aim was to determine whether neuropathy contributes to pedal control errors during complex driving situations such as sharp bends or demanding segments of a route.

Background: diabetes, neuropathy, and driving

Diabetic peripheral neuropathy is characterized by damage to nerves outside the brain and spinal cord, especially in the feet and lower legs. Symptoms range from numbness and tingling to reduced sensitivity to pressure. Notably, many individuals with neuropathy report no obvious symptoms, which means some may drive without recognizing the impairment. The study connects this sensory deficit to real world safety concerns on the road, emphasizing the broader context in which a significant fraction of drivers could be affected, including commercial drivers who may have higher diabetes prevalence according to related safety reports.

Study design and key findings

In the driving simulator, participants faced demanding segments of the route, including sharp bends. Those with diabetic peripheral neuropathy showed a specific mistake pattern: they pressed the accelerator when braking was required, a pedal confusion error not observed among drivers without neuropathy. This suggests that neuropathy can degrade the brain's ability to map foot position and movement to pedal action during rapid maneuvers. The authors interpret this as evidence that nerve damage associated with diabetes contributes to pedal errors, providing a potential mechanism for crash risk increases in this population. The study also builds on prior work showing different accelerator usage patterns and impaired ankle proprioception in neuropathic drivers, reinforcing a theme that foot sensation underpins safe pedal control.

Mechanisms: foot sensation, proprioception, and eye–foot coordination

The research outlines how damaged nerve pathways reduce the reliability of feedback about foot position from the feet to the brain. In rapid maneuvers, diminished proprioception can make it harder to determine which pedal is being touched. Observations from participants with neuropathy indicated they looked down at their feet while driving, using vision to confirm pedal position, whereas drivers without neuropathy did not. These findings align with earlier studies showing altered ankle proprioception and eye movement coordination in neuropathic drivers, suggesting a multi-modal deficit (sensorimotor and oculomotor) may contribute to pedal errors.

Context and policy implications

The article notes that diabetic nerve damage is common and can develop with few symptoms, which is particularly relevant for work drivers. A 2025 Diabetes Safety Organisation report estimated diabetes prevalence among commercial drivers, highlighting that a sizeable share of the road transport workforce could be affected. UK driving guidance already recognises that peripheral neuropathy can impact driving, but current guidance does not advocate routine driving assessments for neuropathy. The study’s authors argue for integrating signs of neuropathy detected in routine care into driving-related questions and further assessments where appropriate, potentially prompting vehicle adaptations or targeted interventions.

Reducing pedal errors: possible interventions and next steps

The researchers discuss several potential strategies to mitigate pedal errors. These include acceleration limiters to cap acceleration when the wrong pedal is pressed and improved footwell lighting to aid foot position awareness. They also consider the possibility that driving a manual transmission could dampen pedal responses, given the gear’s limits on how the car responds to accelerator input. Importantly, the authors caution that any interventions will require robust testing before being recommended as safety measures. The next step is to connect existing knowledge about diabetic foot sensation with the actual driving demands and to evaluate practical safeguards that could reduce the severity or frequency of pedal errors on the road.

Conclusion

Overall, the study adds to a growing understanding of how diabetes related neuropathy can affect everyday activities like driving. By showing a concrete link between foot sensation loss and pedal errors in a simulator, the research highlights the importance of routine foot examinations for people with diabetes and suggests that targeted, evidence based interventions could enhance road safety for a substantial portion of drivers. Further work is needed to test the proposed interventions and to determine how best to implement routine driving assessments in the presence of diabetic neuropathy.