Dr. David Fletcher
In years past the medical decision-making for DOT Medical Examiners for drivers who required insulin to control their diabetes was easy. It was one of four absolute disqualifications for driver who wanted medical certification to drive a commercial motor vehicle. Like the loosening of requirements for drivers with vision, hearing, and seizure issues, the Federal Motor Carrier Safety Administration (FMCSA) has provided new options for drivers with properly controlled insulin-treated diabetes mellitus (ITDM) to be qualified to operate commercial motor vehicles (CMVs) in interstate commerce.
Effective November 19, 2018, FMCSA revised its regulations to permit individuals with a stable insulin regimen and properly controlled insulin-treated diabetes mellitus (ITDM) to be qualified to operate commercial motor vehicles (CMVs) in interstate commerce. Previously, ITDM individuals were prohibited from driving CMVs in interstate commerce unless they obtained an exemption from FMCSA, which was expensive to comply and took almost three months to qualify. This rule enables a certified medical examiner (ME) to grant an ITDM individual a Medical Examiner’s Certificate (MEC), MCSA-5876, for up to a maximum of 12 months. To do so, the treating clinician (TC), the healthcare professional who manages, and prescribes insulin for, the treatment of the individual’s diabetes, provides the Insulin-Treated Diabetes Mellitus Assessment Form (ITDM Assessment Form), MCSA-5870, to the certified ME indicating that the individual maintains a stable insulin regimen and proper control of his or her diabetes.
The certified ME then determines that the individual meets FMCSA’s physical qualification standards and can operate CMVs in interstate commerce.
This new rule eliminates all prior diabetic waivers and exemptions that required approval by FMCSA for ITDM-drivers to qualify to drive a Commercial Motor Vehicle (CMV) and shifts a lot of the liability back to the medical examiner to make an appropriate certification decision when asked to determine fitness for driving.
Managing diabetes for a long-haul operator that requires insulin treatment on the road can be very challenging dealing with syringes, needles, and blood glucose monitoring in less than ideal sterile environment. Factors such as fatigue, lack of sleep and exercise, disruptions in circadian rhythm, poor diet, limited access to consistent medical treatment, stress, smoking, and other chronic illnesses compound the dangers for the ITDM driver.
Occupational health programs that perform Commercial Driver Medical Exams (CDME) must stay current on these ever-changing regulations regarding drivers who take insulin and also budget extra-time and charge more for these complicated exams.
The first special diabetes waiver study program was established in 1993 as part of a research study to investigate whether drivers with insulin-treated diabetes admitted to the program could safely operate CMVs. Participating drivers were required to have a minimum of three years of recent CMV driving experience while using insulin, a safe driving record, and certification by an endocrinologist and an ophthalmologist. As a result of litigation that waiver program was terminated in 1996. The diabetic waiver drivers who qualified in this study program received a FMCSA-issued letter that states the driver may be qualified by operation of 49 CFR 391.64(a).
There are still roughly a 100 drivers from the mid ‘90s waiver program still driving with old diabetic waivers. They have been who grandfathered for more than two decades with proof of original FMCSA letter from 1996 granting them the right to continue to drive under §391.64. However, their grandfather status will end with the new rule that went into effect on November 11, 2018. These drivers will have until November 19, 2019 to comply with new diabetes certification regulations.
That waiver program was replaced by the first ITDM exemption program that was put in place in 2003. The initial rule contained very stringent stipulations that made it very hard for IDDM truck drivers to qualify. In fact, between 2003 and 2005, only four exemptions were granted to diabetic truck drivers.
On November 8, 2005, the FMCSA overturned some of the harsh rules in the 2003 diabetic exemption program. The agency started accepting applications for the revised diabetic exemption program on September 22, 2005. This exemption program still was not that easy to obtain and required their application to be published in the Federal Register.
To apply for a diabetes exemption under the old program administered by FMCSA, the individual had to submit a letter application with medical documentation showing the following:
- The ITDM individual has been examined by a board-certified or board eligible endocrinologist who has (i) conducted a comprehensive evaluation including one glycosylated hemoglobin test (HbA1C) with a result within a range of 7 to 10 percent, inclusive, and (ii) signed a statement regarding his or her determinations;
- The ITDM individual has obtained a signed statement from an ophthalmologist or optometrist indicating that the individual has been examined, has no unstable proliferative diabetic retinopathy, and meets the vision standard in § 391.41(b)(10); and
- The ITDM individual has obtained a signed copy of both a certified ME’s Medical Examination Report Form, MCSA-5875, and an MEC, MCSA-5876, showing that the individual meets all physical qualification standards in § 391.41(b) other than the diabetes standard.
FMCSA made its decision whether to grant the exemption based on individual applications and supporting documentation from healthcare professional and issued a diabetic exemption certificate number that the ME put in the medical certificate.
This diabetes exemption application review by FMCSA took a long time. Processing time for 3,674 exemption applications accepted between 2012 and 2016 through the centralized FMCSA diabetes exemption program took an average of 77 days to make a decision.
This lengthy review process has now been completely eliminated. Certification is now up to the medical examiner (ME) as long as the driver can meet all the other physical qualification requirements of 391.41(b) and they have their treating clinician (TC) complete the new MCSA-5870 form and submit it to the ME with-in 45 days.
According to FMCSA analysis revising these regulations will reduce the regulatory burden and result in a $6.21 million cost savings per year – the aggregate of cost savings to ITDM drivers, motor carriers that hire ITDM individuals, and FMCSA.
 Federal Motor Carrier Safety Administration
49 CFR Part 391
[Docket No. FMCSA–2005–23151]
Qualifications of Drivers; Diabetes Standard
AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT.
ACTION: Final rule.