FMCSA Seeking Comment on Medical Review Board's Diabetes Recommendations

The Federal Motor Carrier Safety Administration is seeking public comment on a slate of guidelines recommended by the agency’s medical experts for drivers with diabetes to operate commercial motor vehicles.

FMCSA’s medical review board guidelines follow a May 2015 proposed rule that would allow drivers with diabetes mellitus to be qualified to operate CMVs in interstate commerce. The notice of proposed rulemaking would enable individuals with the condition to obtain a medical examiner's certificate at least annually. The stipulation is that evidence is presented by the treating clinician that the driver’s condition is stable and well-controlled.

General regulatory requirements deem a person physically qualified to drive a CMV only if that person has no established medical history or clinical diagnosis of diabetes mellitus currently requiring insulin for control.

However, since 2003, FMCSA has maintained an exemption program for individuals that use insulin to treat diabetes.

Diabetes mellitus is a disease in which the body is unable to maintain normal function of insulin, a substance that controls glycemic levels in the blood.

“Diabetes presents a major health challenge, particularly those who drive CMVs in interstate commerce,” the agency’s Sept. 8 pre-publication announcement said. FMCSA is seeking comment on the medical review board’s recommendations for 60 days after it is published in the Federal Register.

The medical review board said that not only should drivers obtain recommendations by their physicians, but they also 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.

The medical board also recommended that examiners be allowed to certify drivers with the disease as medically qualified for a time period of no longer than one year and only if the driver has not experienced any of eight disqualifying factors::

• Any episode of severe hypoglycemia within the previous six months.

• Blood sugar less than 60 milligrams per deciliter demonstrated in current glucose logs.

• Hypoglycemia appearing in the absence of warning symptoms.

• An episode of severe hypoglycemia, blood sugar less than 60 mg/dl.

• Uncontrolled diabetes, as evidenced by Hemoglobin A1c level greater than 10%.

• Stage 3 or 4 diabetic retinopathy (a driver should be permanently disqualified).

• Signs of target organ damage.

• Inadequate record of self-monitoring of blood glucose.