FMCSA Seeking Comment on Diabetes Proposal through Nov. 8

The Federal Motor Carrier Safety Administration is asking for public comment on proposed medical guidelines for drivers with diabetes mellitus to operate commercial motor vehicles.

Diabetes mellitus is a disease manifested by the body’s inability to maintain normal function of insulin, a substance that controls glycemic levels in the blood, the Agency said in a notice in the Federal Register. Further, according to the notice:

“Diabetes presents a major health challenge, particularly [for] those who drive CMVs in interstate commerce.” Under federal regulations, 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. However, since 2003, FMCSA has maintained an exemption program for individuals that use insulin to treat their diabetes mellitus, which allows them to drive in interstate commerce if their diabetes is stable and they meet criteria of the program.

In May 2015, FMCSA issued a Notice of Proposed Rulemaking in the Federal Register to allow drivers with stable, well-controlled ITDM to be qualified to operate CMVs in interstate commerce. The NPRM would enable individuals with ITDM to obtain a Medical Examiner’s Certificate (MEC) from a Certified Medical Examiner (CME) at least annually in order to operate in interstate commerce as long as evidence is presented by the treating clinician who prescribes insulin documenting that the driver’s condition is stable and well-controlled. The comment period on the NPRM closed on July 6, 2015, and the Agency received more than 1,250 comments. It asked the Medical Review Board to evaluate the comments and come up with recommendations.

The Medical Board’s final report, published in the Federal Register, contains a number of detailed recommendations for FMCSA to consider as it develops a final rule.

The Board recommended that ITDM drivers be medically disqualified unless they meet the following requirements demonstrating their stable, well-controlled ITDM:

1. The driver must provide an FMCSA Drivers With Insulin Treated Diabetes Mellitus Assessment Form(set out in the recommendations) 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 (using the International Classification of Diabetic Retinopathy and Diabetic Macular Edema).

The Board recommended that medical examiners be allowed to certify an ITDM driver as medically qualified for a time period of no longer than one year only if the driver has not experienced any of the following eight disqualifying factors:

1. Any episode of severe hypoglycemia within the previous six months.
2. Blood sugar less than 60 milligrams per deciliter (mg/dL) demonstrated in current glucose logs.
3. Hypoglycemia appearing in the absence of warning symptoms (i.e.,hypoglycemic unawareness).
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 (HbA1c) level greater than 10%. A driver could be reinstated when HbA1c level is less than or equal to 10%.
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 MRB stated that, if a driver is medically disqualified due to not meeting the ITDM criteria listed above, the driver should remain disqualified for at least six months.

Comments must be received on or before Nov. 8, 2016. Go to www.regulations.gov and follow the on-line instructions for submitting comments. Each submission must include FMCSA and docket number FMCSA-2005-23151.