A new Federal Motor Carrier Safety Administration (FMCSA) proposal would issue exemptions to certain insulin-using diabetic drivers of commercial motor vehicles from the diabetes mellitus prohibitions contained in the FMCSA rules, according to information published in the July 31 Federal Register.
The agency established the current standard for diabetes in 1970 because several risk studies indicated that diabetic drivers had a higher rate of accident involvement than the general population. The diabetes requirement provides: 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. 49 CFR 391.41(b)(3).
There are special conditions attached to the issuance of any exemption. The following requirements would be imposed:
(1) Individuals shall maintain appropriate medical supplies for glucose management while preparing for the operation of a CMV and during its operation. The supplies should include the following: An acceptable glucose monitor with memory; Supplies needed to obtain adequate blood samples and to measure blood glucose; Insulin to be used as necessary; and An amount of rapidly absorbable glucose to be used as necessary.
(2) Prior to and while driving, the individual shall adhere to the following protocol for monitoring and maintaining appropriate blood glucose levels: Check glucose before starting to drive and take corrective action if necessary. If glucose is 100 mg/dl, take glucose or food and recheck in 30 minutes. Do not drive if glucose is 100 mg/dl. Repeat the process until glucose is >100 mg/dl; While driving check glucose every two to four hours and take appropriate action to maintain it in the range of 100 to 400 mg/dl; Have food available at all times when driving. If glucose is 100 mg/dl, stop driving and eat. Recheck in 30 minutes and repeat procedure until glucose is >100 mg/dl; and If glucose is >400 mg/dl, stop driving until glucose returns to the 100-400 mg/dl range. If more than two hours after last insulin injection and eating, take additional insulin. Recheck blood glucose in 30 minutes. Don't resume driving until glucose is 400 mg/dl.
In addition to the requirements for controlling the disease, exemption recipients will be monitored during the period that the exemption is valid. Monitoring will be conducted by requiring the exemption recipients to submit the following information to the FMCSA:
(1) Submit to a comprehensive medical evaluation by an endocrinologist on an annual basis. The evaluation will include a general physical examination and a report of glycosylated hemoglobin concentration. The evaluation will also involve an assessment of the individual's willingness and ability to monitor and manage the diabetic condition.
(2) Provide records of all daily glucose measurements taken with an acceptable device (with memory). These measurements will be reviewed by a specialist on a quarterly basis.
(3) Provide on an annual basis confirmation by an ophthalmologist that there is no proliferative diabetic retinopathy and no clinically significant disease that prevents the individual from meeting the current vision standards at 49 CFR 391.41(b)(10).
(4) Annual documentation by an endocrinologist of ongoing education in management of diabetes and hypoglycemia awareness.
(5) Report, upon determination of an endocrinologist or other physician, any episode of severe hypoglycemia, significant complications or inability to manage diabetes.
(6) Report any involvement in an accident or any other adverse event and whether or not they are related to an episode of hypoglycemia.