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.
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.
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.
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.
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.