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Lehmann, Vera ORCID logoORCID: https://orcid.org/0000-0002-6038-809X; Zueger, Thomas ORCID logoORCID: https://orcid.org/0000-0001-6190-7405; Maritsch, Martin ORCID logoORCID: https://orcid.org/0000-0001-9920-0587; Notter, Michael ORCID logoORCID: https://orcid.org/0009-0002-8404-570X; Schallmoser, Simon ORCID logoORCID: https://orcid.org/0000-0003-4076-0584; Bérubé, Caterina ORCID logoORCID: https://orcid.org/0000-0001-5247-8485; Albrecht, Caroline ORCID logoORCID: https://orcid.org/0009-0001-3669-0192; Kraus, Mathias ORCID logoORCID: https://orcid.org/0000-0002-2021-2743; Feuerriegel, Stefan ORCID logoORCID: https://orcid.org/0000-0001-7856-8729; Fleisch, Elgar ORCID logoORCID: https://orcid.org/0000-0002-4842-1117; Kowatsch, Tobias ORCID logoORCID: https://orcid.org/0000-0001-5939-4145; Lagger, Sophie ORCID logoORCID: https://orcid.org/0009-0004-5313-7518; Laimer, Markus ORCID logoORCID: https://orcid.org/0000-0002-7622-0822; Wortmann, Felix ORCID logoORCID: https://orcid.org/0000-0001-5034-2023 und Stettler, Christoph ORCID logoORCID: https://orcid.org/0000-0003-1691-6059 (2024): Machine Learning to Infer a Health State Using Biomedical Signals — Detection of Hypoglycemia in People with Diabetes while Driving Real Cars. In: NEJM AI, Bd. 1, Nr. 3 [PDF, 524kB]

Abstract

Background

Hypoglycemia, one of the most dangerous acute complications of diabetes, poses a substantial risk for vehicle accidents. To date, both reliable detection and warning of hypoglycemia while driving remain unmet needs, as current sensing approaches are restricted by diagnostic delay, invasiveness, low availability, and high costs. This research aimed to develop and evaluate a machine learning (ML) approach for the detection of hypoglycemia during driving through data collected on driving characteristics and gaze/head motion.

Methods

We collected driving and gaze/head motion data (47,998 observations) during controlled euglycemia and hypoglycemia from 30 individuals with type 1 diabetes (24 male participants; mean ±SD age, 40.1±10.3 years; mean glycated hemoglobin value, 6.9±0.7% [51.9±8.0 mmol/mol]) while participants drove a real car. ML models were built and evaluated to detect hypoglycemia solely on the basis of data regarding driving characteristics and gaze/head motion.

Results

The ML approach detected hypoglycemia with high accuracy (area under the receiver-operating characteristic curve [AUROC], 0.80±0.11). When restricted to either driving characteristics or gaze/head motion data only, the detection performance remained high (AUROC, 0.73±0.07 and 0.70±0.16, respectively).

Conclusions

Hypoglycemia could be detected noninvasively during real car driving with an ML approach that used only data on driving characteristics and gaze/head motion, thus improving driving safety and self-management for people with diabetes. Interpretable ML also provided novel insights into behavioral changes in people driving while hypoglycemic.

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