Federal Update
Wave bye-bye to diabetes waiver requirements?
Agency seeks comments on scrapping waiver requirement altogether for insulin-dependent truckers

By Jami Jones
senior editor

Insulin and trucking don't go together - at least they didn't, as far as the regs were concerned.

But in late 2005, the nearly impossible three-year driving requirement was eliminated from the waiver process and minimum periods proving insulin control hit the scene. FMCSA is now toying with the idea of eliminating the need to apply for a waiver at all.

An "advance notice of proposed rulemaking" and request for comments was published in the Federal Register in March. The notice stated agency officials are considering amending the medical qualifications standards to eliminate waiver requirements.

"Upon completion of this rulemaking, drivers . might not be required to apply for exemptions from the current rule," the notice stated.

The notice asks those who comment to address specific questions.

The following is a summary of the questions relevant to truckers:

  1. What changes to the current regulation (49 CFR 391.41) should be considered to enable insulin-dependent diabetics to drive without a waiver?
  2. How should FMCSA officials make sure doctors apply the medical standard consistently and appropriately to make sure truckers are physically able to operate safely and that driving a truck is not harmful to their health?
  3. Comments on the elimination of the three-year driving requirement and minimum period of control requirement are also requested.
  4. Should a doctor assume responsibility for the determination that a trucker can manage their diabetes or should the doctor be required to certify the trucker meets the revised standard?
  5. Should the medical certificate issued by the medical examiner also have certification from the treating physician in addition to the medical examiner?
  6. What should be the standard maximum period for valid medical certificates for insulin-dependent diabetics?
  7. What changes in health should be reported - for example hypoglycemia-induced incidents? What changes in crash data should be reported? Who should be responsible for these reports and who should the reports be submitted to?
  8. Should new and emerging treatments be considered in reviewing and revising the current standard? How would new treatments affect implementation of a new standard?
  9. Are there attributes to being a trucker that make it particularly difficult to manage diabetes? Are any of these attributes specific to particular segments of the industry?

The additional questions asked if states would adopt uniform rules regarding diabetics and requested studies on insulin-dependent truckers.

Where to send comments
The comment deadline is June 15. Comments can be submitted anonymously. All submissions must include the agency name and docket number, FMCSA-2005-23151.

To submit your completed comments, you can:

  • Fax to: (202) 493-2251; or
  • Mail to:
    Docket Management Facility
    U.S. Department of Transportation
    400 Seventh St. SW, Nassif Building Room PL-401
    Washington, DC 20590-0001


Regulation sidelining diabetics goes back to 1971

The pee test that diabetic truckers have dreaded for years has nothing to do with drugs and everything to do with sugar.

Beginning in 1940, under the Interstate Commerce Commission’s Motor Carrier Safety Regulations, truckers have been subjected to urine glucose tests as part of medical exams that determine if they are physically qualified to drive interstate.

It wasn’t until 1971 that the Federal Highway Administration – which governed trucking before the Federal Motor Carrier Safety Administration – established the current standard.

It states that a ‘‘person is physically qualified to drive a commercial motor vehicle if that person has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control.’’

The rule came about because several crash studies “indicated that drivers with insulin-dependent diabetes … had higher rates of crashes compared to the general driving public.”

That 1971 standard ended the chance of insulin-dependent diabetics from driving interstate.

An attempt was made in 1977 to modify the standard, but the rulemaking process was terminated with no changes to the reg.

Real changes started in 1987 when FHWA published an “advanced notice of proposed rulemaking” – at the urging of two truckers and the American Diabetes Association – to eliminate the blanket prohibition.

Studies were published. Comments were gathered.

In fact, in 1990 FHWA sponsored a risk assessment that looked at the number of crashes involving insulin-dependent diabetic drivers. The assessment found that the level of crashes for those drivers was similar to that of drivers without diabetes.

In 1992 a waiver program was implemented. Trick was, it required three years of driving as part of the criteria. A tough proposition because insulin-dependent diabetics hadn’t been allowed to drive interstate since 1971.

The waiver faced challenges as well. It was terminated because of a procedural problem and put back in place once the bugs were worked out. But the three-year driving requirement remained.

It wasn’t until 1998 when Congress mandated FHWA officials to determine if it was feasible to develop a screening, operating and monitoring program that would allow insulin-dependent diabetics back on the road – if safety was equal to or greater than with the blanket prohibition.

When FMCSA was created in 1999, the directive from Congress followed. Studies were conducted and reports were made. In 2003, FMCSA implemented its new protocol.

The highway funding legislation this past year further tweaked FMCSA’s waiver program by mandating elimination of the three year requirement and mandating establishment of a specified minimum period of insulin use to demonstrate stable control of diabetes.

Those changes became effective Nov. 8, 2005.

Now, FMCSA is taking it a step further. The agency is toying with the idea of eliminating the hurdle of the waiver process insulin-dependent truckers.