Should the American DiabetesAssociation be setting driving license guidelines for people with diabetes? This isa topic for discussion as the ADA has done exactly this for 2012 and2013. Check out the 2013 guidelines here. In discussing this withinour informal group, there are mixed feelings. A few feel that theADA should not have made a statement about this. Most of us think itmay be a good thing. Even those of us feeling good about this havemixed emotions at some point.
Since I have some experience as atrucking safety director, I was probably given the most attention. The fact that the Department of Transportation (DOT) has, in the lastfive years, allowed people with diabetes to have a commercialdriver’s license (CDL), we have to think that this speaks volumesand this was without the ADA guidelines. When I retired, people withdiabetes were not allowed to drive with a CDL. I was aware of astudy being done by the DOT and some drivers being regularly testedand allowed to drive with diabetes, but only as part of the study. Now they are able to drive with diabetes, but must be evaluated everytwo years. Their diabetes doctors can stop this at anytime if thepatient is not managing their diabetes.
Most people are able to drive a carwith a regular driver’s license. Many states already have laws onthe books about physicians reporting when it was felt people withdiabetes were not responsible enough to drive or did not manage theirdiabetes in a responsible manner. Most all of us agree with thestatement of writing group chair Daniel Lorber, MD, FACP, CDE, amember of the ADA Professional Practice Committee and director ofendocrinology at New York Hospital of Queens in Flushing, when hesays about the 2012 guidelines, “Thiscountry needs a far more consistent, fair and equitable means ofdetermining driving risk when it comes to people with diabetes. Thevast majority of people with diabetes have no problems driving safelywhatsoever, and should not be held to restrictions that may interferewith their ability to work or live an otherwise normal life.”
Consistency is always good, if this isindeed the goal. I do wonder if anyone is actually looking at thelaws of the different states and trying to propose legislation tobring laws into consistency. We do need this and if the ADA isworking to make the following statement work and be consistent acrossthe medical profession, this may be a small start. “Thestatement, therefore, highlights the need to identify thoseindividuals, who are at high risk for unsafe driving, and to designand implement strategies to lower this risk.”
Our group also wonders if the doctorswill be consistent in the way they report to the state about theirassessment of the diabetes patients. Many people are concerned thatsome doctors will be more hard-nosed about this and try to have somepatients lose their license. We are aware of some doctors that don'tcare and will not assess drivers with diabetes, while others that arebeing very hard-nosed about this and reporting almost 50 percent oftheir patients.
This is when patients are going torealize that these doctors have done nothing to educate them aboutdiabetes and what to do to manage it more effectively. We haveseveral members of our informal group that are very concerned. Theyhave stated that if it was not for our group, they would have verylittle education. They have had their doctor ask them continuouslyabout hypoglycemia and how often they have had it. Since only one ofthem has had one time with hypoglycemia, the doctor is claiming thatthey are not being honest and is becoming very belligerent about it. Yes, the three of them have had excellent A1c's. Two were 5.8% andthe other 5.7%. The doctor says they all should be above 6.5% andnearer 7.0%. We have all urged them to consider finding a differentdoctor.
All three are between 56 years and 64years of age and still working at jobs they love. One has finallyfound a different doctor and is much happier as the doctor has askedabout hypoglycemia and after he explained, he is eating low carb,getting daily exercise, and has not had hypoglycemia or readingsbelow 75 mg/dl. The doctor did download his meter and reviewed thelog and said there was no indications of hypoglycemia. His latestA1c was 5.6% and the doctor just told him to continue what he isdoing. They did discuss medications and the doctor asked if hewanted to go back to oral medications, but did not go farther whentold no.
Most of our group feels that there aresome people that are not paying enough attention to their bloodglucose levels before driving. One of our group has a type 1neighbor that has been taken to the hospital several times in thelast year for extreme hypoglycemia and still drives. He does wonderif he will continue to have accidents like he has in the neighborhoodand still be able to drive.
The section on driving with diabetes onthe guidelines is rather lengthy, but has a lot of good informationthat patients need to understand to avoid problems and not put theirdriving privileges at risk.
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