Trucking With Diabetes - Newest Regulations For 2018

Last Updated: Oct 30, 2018

If you have insulin-treated Type 2 or insulin-dependent Type 1 diabetes mellitus, you can now operate a Commercial Motor Vehicle in interstate commerce without obtaining an exemption from the Federal Motor Carrier Safety Administration, effective November 19, 2018.

ITDM individuals who plan to drive interstate will now be able to get a Medical Examiner’s Certificate (MEC) that is to be renewed annually. An MEC is required to obtain a CDL . People with diabetes who do not need insulin were already not required to obtain an exemption, and that is still the case.

The new process for those affected will require the treating clinician (“TC”—the healthcare professional who manages and prescribes insulin for the patient’s diabetes) to provide the certified Medical Examiner with an ITDM Assessment Form, MCSA-5870, showing that the prospective driver maintains a stable insulin regimen and proper control of their diabetes. The examiner then determines as they normally would for any other driver whether the individual will pass the DOT physical by meeting the FMCSA physical qualification standards in all necessary health areas.

Average A1C Level

A significant piece of the examinations for those with diabetes will include their A1C level, which reflects average blood sugar level for the previous two or three months. For the FMCSA , the driver’s A1C must be 7- 10%. This is not a change - however, now the driver whose non-insulin dependent diabetes develops into insulin dependency will no longer face a major disruption in their career. Many drivers who are experiencing this shift currently go to great lengths to try to keep from needing insulin in order to avoid entering the exemption process, which involves passing 57 screenings.

See the official text of the new FMCSA rule

How did commercial driving with diabetes work before?

In recent history, those with ITDM were prohibited from driving CMVs in interstate commerce unless they obtained an exemption from FMCSA, and that process was lengthy. This system, the Diabetes Exemption Program, began in 2003. Prior to that, there was a blanket ban on trucking with the condition.

When the exemption program began, it entailed a “three-year-rule,” in which ITDM drivers must have already driven a commercial vehicle for three years before being able to obtain the exemption. To do that, the driver would have had to live in a state that allowed ITDM driving intrastate (within state lines), which was rarely considered commercial, so in effect this was lip service. In 2005, the three-year rule was abandoned, but the lengthiness of the process to obtain the exemption remained.

Timeline For Diabetes Regulation In Trucking

  • 1939—a predecessor of the FMCSA recommended that prospective drivers be required to have glucose tested via urine, but people with diabetes were not yet indiscriminately banned from driving.
  • 1970—the FMCSA established 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”—a blanket ban on all who needed to use insulin, due to studies at the time indicating that drivers with diabetes were involved in more crashes than the general population.
  • 1993-1994—ITDM individuals could apply for a waiver in 1993, but that program was ended the following year.
  • 2000—The FMCSA submitted a report to Congress concluding that it was feasible to establish a safe and practicable protocol by screening qualified ITDM commercial drivers, establishing operational requirements to ensure proper disease management by drivers, and monitoring safe driving behavior and proper disease management.
  • 2003—the Diabetes Exemption Program began, featuring the three-year rule.
  • 2005—the three-year rule was discarded, but the exemption program remained otherwise the same.
  • 2015—The FMCSA proposes to permit drivers with a stable, well-controlled ITDM to be qualified to operate a commercial vehicle in interstate commerce.
  • Effective November 19, 2018—the exemption program ends, at which time ITDM individuals are able to obtain a Medical Examiner’s Certificate annually if physical fitness is deemed sound, the same as for other drivers, and the FMCSA Medical Examiner is provided with the ITDM Assessment Form by the treating clinician.

Read about the history of diabetes regulation by the FMCSA in their 2015 proposal

Benefits of the 2018 diabetes regulation

The FMCSA has highlighted several strong reasons for the 2018 regulation repealing the exemption program.

  • It was determined that the new allowance would achieve a level of safety equivalent to or greater than the level that would be achieved by complying with the current regulation.
  • The change delivers economic savings to affected drivers and to the FMCSA, and streamlines processes by eliminating unnecessary regulatory burdens and redundancy.
  • The final rule will eliminate the exemption program that currently requires individuals with ITDM to incur recurring costs to renew and maintain their exemptions.  FMCSA estimates this will save the nearly 5,000 individuals with ITDM that currently have exemptions more than $5 million per year more than what they would endure under the exemption program.  The final rule will also save new ITDM exemption applicants and their associated motor carriers approximately $215,000 annually in opportunity and compliance costs related with the exemption program’s waiting period.
  • As an agency, FMCSA will save more than $1 million per year over the next three years in costs associated with administering the diabetes exemption program.

Background: Why trucking with diabetes involves federal regulation

Why is being diabetic an issue for trucking in the first place? A 2006 medical expert panel presentation to the FMCSA explored four “key questions” that demonstrate why diabetes in commercial driving is a concern to regulatory bodies, and what kinds of issues inform their policies. Those questions were as follows:

  • Are individuals with diabetes mellitus at increased risk for a motor vehicle crash when compared with comparable individuals who do not have diabetes? The panel found the answer to this to be inconclusive.
  • Is hypoglycemia an important risk factor for a motor vehicle crash among individuals with diabetes mellitus? The panel stated that this could not be answered due to too many various factors. Hypoglycemia can cause loss of consciousness.
  • What treatment-specific risk factors are associated with an increased incidence of severe hypoglycemia among individuals with diabetes mellitus? The panel concluded that there were not enough studies on this, and also that hypoglycemia is not even the most important risk factor for diabetic drivers.
  • How effective is hypoglycemia awareness training in preventing consequences of hypoglycemia? Again, it was concluded that this was unclear.

Read the full report here about diabetics in trucking from 2006

The American Diabetes Association celebrates the 2018 legislation as a major victory in a decades-long fight to change the rules that govern commercial drivers with diabetes. They viewed blanket restrictions on individuals with diabetes as discriminatory, and cite data that show that these individuals do not pose an unacceptable risk to public safety on the grounds of their condition.

Health risks for truck drivers

While diabetes as a disqualifier to enter commercial driving has gone through its lengthy, contentious regulatory history, the kicker is that existing truck drivers are more likely to develop Type 2 diabetes as a direct result of their occupational lifestyle than the rest of the population due to the necessity of sitting for extremely long periods of time and often being limited to unhealthy food at truck stops. The effort and ingenuity needed to skirt these tendencies does not always come naturally to drivers.

According to 2014 research by the Transportation Research Board, long haul truck drivers in the U.S. have a greatly increased prevalence over the larger population of major health risks and conditions across the board—obesity, morbid obesity, self-reported diabetes (14% over 7%), cardiovascular risk factors, smoking, and lack of health insurance.

A study by the National Institutes of Health actually shows that truck drivers who are severely obese (not diabetic), have a 47% to 63% higher crash rate than drivers with a Body Mass Index within the healthy range. Other health conditions besides diabetes often force drivers out of the profession due to their inability to meet the physical requirements.

Read the NIH study on the health of truck drivers

Read the TRB health and injury survey of long haul drivers

There are many resources online for drivers to learn how to stay healthy on the road in order to avoid developing health conditions that might be preventable, of which Type 2 diabetes is only one. As convenient as it is to eat fast food at truck stops, it can take its toll and eventually warrant undesirable involvement by Uncle Sam. Health problems that often result from choosing unhealthy food at a majority of meals in a position that involves sitting for 11 hours a day can jeopardize your career in driving, which is much more expensive, ultimately, than learning as much as you can about ways to make healthy choices while driving. That is one thing that the new diabetes regulation does not change.

CDL:

Commercial Driver's License (CDL)

A CDL is required to drive any of the following vehicles:

  • Any combination of vehicles with a gross combined weight rating (GCWR) of 26,001 or more pounds, providing the gross vehicle weight rating (GVWR) of the vehicle being towed is in excess of 10,000 pounds.
  • Any single vehicle with a GVWR of 26,001 or more pounds, or any such vehicle towing another not in excess of 10,000 pounds.
  • Any vehicle, regardless of size, designed to transport 16 or more persons, including the driver.
  • Any vehicle required by federal regulations to be placarded while transporting hazardous materials.

Commercial Motor Vehicle:

A commercial motor vehicle is any vehicle used in commerce to transport passengers or property with either:

  • A gross vehicle weight rating of 26,001 pounds or more
  • A gross combination weight rating of 26,001 pounds or more which includes a towed unit with a gross vehicle weight rating of more than 10,000 pounds
  • CSA:

    Compliance, Safety, Accountability (CSA)

    The CSA is a Federal Motor Carrier Safety Administration (FMCSA) initiative to improve large truck and bus safety and ultimately reduce crashes, injuries, and fatalities that are related to commercial motor vehicle

    FMCSA:

    Federal Motor Carrier Safety Administration

    The FMCSA was established within the Department of Transportation on January 1, 2000. Their primary mission is to prevent commercial motor vehicle-related fatalities and injuries.

    What Does The FMCSA Do?

    • Commercial Drivers' Licenses
    • Data and Analysis
    • Regulatory Compliance and Enforcement
    • Research and Technology
    • Safety Assistance
    • Support and Information Sharing

    DOT:

    Department Of Transportation

    A department of the federal executive branch responsible for the national highways and for railroad and airline safety. It also manages Amtrak, the national railroad system, and the Coast Guard.

    State and Federal DOT Officers are responsible for commercial vehicle enforcement. "The truck police" you could call them.

    CMV:

    Commercial Motor Vehicle

    A CMV is a vehicle that is used as part of a business, is involved in interstate commerce, and may fit any of these descriptions:

    • Weighs 10,001 pounds or more
    • Has a gross vehicle weight rating or gross combination weight rating of 10,001 pounds or more
    • Is designed or used to transport 16 or more passengers (including the driver) not for compensation
    • Is designed or used to transport 9 or more passengers (including the driver) for compensation
    • Is transporting hazardous materials in a quantity requiring placards

    Interstate Commerce:

    Commercial trade, business, movement of goods or money, or transportation from one state to another, regulated by the Federal Department Of Transportation (DOT).

    Interstate:

    Commercial trade, business, movement of goods or money, or transportation from one state to another, regulated by the Federal Department Of Transportation (DOT).

    Intrastate:

    The act of purchasers and sellers transacting business while keeping all transactions in a single state, without crossing state lines to do so.

    BMI:

    Body mass index (BMI)

    BMI is a formula that uses weight and height to estimate body fat. For most people, BMI provides a reasonable estimate of body fat. The BMI's biggest weakness is that it doesn't consider individual factors such as bone or muscle mass. BMI may:

    • Underestimate body fat for older adults or other people with low muscle mass
    • Overestimate body fat for people who are very muscular and physically fit

    It's quite common, especially for men, to fall into the "overweight" category if you happen to be stronger than average. If you're pretty strong but in good shape then pay no attention.

    Body Mass Index:

    Body mass index (BMI)

    BMI is a formula that uses weight and height to estimate body fat. For most people, BMI provides a reasonable estimate of body fat. The BMI's biggest weakness is that it doesn't consider individual factors such as bone or muscle mass. BMI may:

    • Underestimate body fat for older adults or other people with low muscle mass
    • Overestimate body fat for people who are very muscular and physically fit

    It's quite common, especially for men, to fall into the "overweight" category if you happen to be stronger than average. If you're pretty strong but in good shape then pay no attention.

    Dm:

    Dispatcher, Fleet Manager, Driver Manager

    The primary person a driver communicates with at his/her company. A dispatcher can play many roles, depending on the company's structure. Dispatchers may assign freight, file requests for home time, relay messages between the driver and management, inform customer service of any delays, change appointment times, and report information to the load planners.

    Fm:

    Dispatcher, Fleet Manager, Driver Manager

    The primary person a driver communicates with at his/her company. A dispatcher can play many roles, depending on the company's structure. Dispatchers may assign freight, file requests for home time, relay messages between the driver and management, inform customer service of any delays, change appointment times, and report information to the load planners.

    HOS:

    Hours Of Service

    HOS refers to the logbook hours of service regulations.

    OWI:

    Operating While Intoxicated

    OOS:

    When a violation by either a driver or company is confirmed, an out-of-service order removes either the driver or the vehicle from the roadway until the violation is corrected.

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