Medical Review Board wants list of 'disqualifying' factors for diabetic drivers

By Mark Schremmer, Land Line staff writer | Friday, September 09, 2016

The Federal Motor Carrier Safety Administration’s Medical Review Board suggests that commercial motor vehicle drivers with diabetes can be certified for one year as long as they haven’t experienced a “disqualifying” episode.

Details of the board’s recommendations regarding drivers who are being treated for diabetes were published in the Federal Register on Friday, Sept. 9. The FMCSA is seeking comments on the board’s recommendations. Comments must be received by Nov. 8.

The review board recommended that medical examiners be allowed to certify a driver with insulin-treated diabetes mellitus for up to one year as long as he or she hasn’t experienced the following disqualifying factors:

  1. Any episode of severe hypoglycemia within the previous six months;
  2. Blood sugar less than 60 milligrams per deciliter demonstrated in current glucose logs;
  3. Hypoglycemia appearing in the absence of warning symptoms;
  4. An episode of severe hypoglycemia, blood sugar less than 60 mg/dl, or hypoglycemic unawareness within the previous six months; the driver should be medically disqualified and must remain disqualified for at least six months;
  5. Uncontrolled diabetes, as evidenced by Hemoglobin A1c level greater than 10 percent. A driver could be reinstated when HbA1c level is less than or equal to 10 percent;
  6. Stage 3 or 4 diabetic retinopathy; a driver should be permanently disqualified;
  7. Signs of target organ damage; a driver should be disqualified until the matter is resolved by treatment, if possible;
  8. Inadequate record of self-monitoring of blood glucose; a driver should be disqualified for inadequate records until the driver can demonstrate adequate evidence of glucose records (minimum one month).

In addition, the Medical Review Board suggested that a driver who is medically disqualified for not meeting the above criteria should remain disqualified for at least six months.

The board also recommended that drivers with insulin-treated diabetes mellitus be disqualified unless they meet the following requirements:

  1. The driver must provide an FMCSA form to a medical examiner that has been completed and signed by the treating clinician. The treating clinician must be a Doctor of Medicine, a Doctor of Osteopathy, a Nurse Practitioner or a Physician’s Assistant who prescribed insulin to the driver and is knowledgeable regarding the treatment of diabetes.
  2. The driver must receive a complete ophthalmology or optometry exam, including dilated retinal exam, at least every two years documenting the presence or absence of retinopathy/macular edema and the degree of retinopathy and/or macular edema if present. 

Since 2003, the FMCSA has allowed diabetes patients who are treated with insulin to drive in interstate commerce through an exemption program. However, the waiver came with the requirement that they have three years’ safe driving experience with the diabetes – which they were prohibited from doing.

Beginning in 2005, drivers could receive a waiver with proof the condition was under control 60 days for Type 1 diabetics and 30 days for those with Type 2 and the driving requirement was dropped.

In 2006, the Owner-Operator Independent Drivers Association filed comments in support of an advanced notice of proposed rulemaking to eliminate the waiver process for insulin-treated truck drivers.

“OOIDA supports amending the existing medical qualification standards to allow drivers with insulin-treated diabetes to operate a commercial motor vehicle in interstate commerce without first obtaining an exemption,” the Association wrote in formal comments from 2006.

In May 2015, the FMCSA issued a notice of proposed rulemaking to allow drivers with stable, well-controlled diabetes to operate commercial motor vehicles in interstate commerce. The rulemaking would enable individuals with insulin-treated diabetes to obtain a medical examiner’s certificate at least annually as long as evidence is presented that the driver’s condition is stable and well-controlled.

Comments regarding the Medical Review Board’s recommendation can be submitted with Docket ID FMCSA-2005-23151 by using the Regulations.gov website, mail, hand delivery or fax. To mail or hand deliver, the address is Docket Management Facility, U.S. Department of Transportation, 1200 New Jersey Ave. SE, West Building, Ground Floor, Room W12-140, Washington, DC 20590-0001. The fax number is 202-493-2251.

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