Special Guest Blog from Kristen Komaiko, PharmD, PGY Resident, St. Louis College of Pharmacy. Development of this blog post was supported by a grant from AHRQ [Lipman/1 R18 HS021952-02].
Chances are that one or more of your patients with diabetes drive commercially for their work. According to the American Trucking Association, approximately 3.5 million commercial truck drivers in the United States collectively drive more than 400 billion miles each year. Being on the road can pose daily challenges for those managing diabetes. Chief among these are difficulty in recognizing the symptoms of hypoglycemia (particularly if driving alone), limited choices of healthy foods amidst abundant choices of convenient foods (burgers, fries and fried chicken), and the relentless pressure to arrive and deliver on time.
And yet, these are not the only challenges presented by the road. People with diabetes who drive commercially in interstate commerce must provide their medical information to the Department of Transportation (DOT) in order to prove control of their diabetes. According to DOT rules, people with diabetes who require insulin for control cannot be approved for DOT certification unless they have a waiver. The application process to obtain a waiver takes 180 days starting from the date that all required information is submitted. While it may seem that the waiver process is cumbersome and quite complex, the statutes are in place to promote the health and wellness of the driver, while simultaneously promoting public safety on the road.
The reason why there is such scrutiny of commercial drivers with diabetes is because complications of diabetes can negatively affect driving ability. Neuropathy can impair the ability to feel the foot pedals. Retinopathy may cause loss of visual acuity, color vision and peripheral vision, all of which can impair the driver’s vision. Hyperglycemia can result in difficulty concentrating, blurred vision and fatigue. Symptoms of hypoglycemia that may affect driving ability include shakiness, anxiety, irritability, confusion/delirium, lightheadedness/dizziness, sleepiness, blurred/impaired vision, headache, lack of coordination, fatigue, seizures, and unconsciousness.
Considerations for the Federal Commercial Driving Medical Evaluation include a review of the driver’s diabetes history, hospitalizations, medications, history of blood glucose readings, vision health, and tests for complications. The driver must NOT have a history of one or more severe hypoglycemic episodes in the past 12 months or 2 or more episodes in the last 5 years that resulted in seizure, loss of consciousness, need for assistance from another person, or a period of impaired cognitive function that occurred without warning.
Frank discussion about recognizing their individual symptoms of hypoglycemia and appropriate corrective action are essential when working with commercial truck drivers with diabetes.
Recommendations for Treating Truck Drivers
Application for the Federal Diabetes Exemption Program form
Quarterly Endocrinologist Evaluation form for Already Exempted Drivers
Annual Diabetes Assessment Package