February 6, 2013

Diabetes and Driving

Should the American Diabetes Association be setting driving license guidelines for people with diabetes? This is a topic for discussion as the ADA has done exactly this for 2012 and 2013. Check out the 2013 guidelines here.  In discussing this within our informal group, there are mixed feelings. A few feel that the ADA should not have made a statement about this. Most of us think it may be a good thing. Even those of us feeling good about this have mixed emotions at some point.

Since I have some experience as a trucking safety director, I was probably given the most attention. The fact that the Department of Transportation (DOT) has, in the last five years, allowed people with diabetes to have a commercial driver’s license (CDL), we have to think that this speaks volumes and this was without the ADA guidelines. When I retired, people with diabetes were not allowed to drive with a CDL. I was aware of a study being done by the DOT and some drivers being regularly tested and allowed to drive with diabetes, but only as part of the study. Now they are able to drive with diabetes, but must be evaluated every two years. Their diabetes doctors can stop this at anytime if the patient is not managing their diabetes.

Most people are able to drive a car with a regular driver’s license. Many states already have laws on the books about physicians reporting when it was felt people with diabetes were not responsible enough to drive or did not manage their diabetes in a responsible manner. Most all of us agree with the statement of writing group chair Daniel Lorber, MD, FACP, CDE, a member of the ADA Professional Practice Committee and director of endocrinology at New York Hospital of Queens in Flushing, when he says about the 2012 guidelines, “This country needs a far more consistent, fair and equitable means of determining driving risk when it comes to people with diabetes. The vast majority of people with diabetes have no problems driving safely whatsoever, and should not be held to restrictions that may interfere with their ability to work or live an otherwise normal life.”

Consistency is always good, if this is indeed the goal. I do wonder if anyone is actually looking at the laws of the different states and trying to propose legislation to bring laws into consistency. We do need this and if the ADA is working to make the following statement work and be consistent across the medical profession, this may be a small start. “The statement, therefore, highlights the need to identify those individuals, who are at high risk for unsafe driving, and to design and implement strategies to lower this risk.”

Our group also wonders if the doctors will be consistent in the way they report to the state about their assessment of the diabetes patients. Many people are concerned that some doctors will be more hard-nosed about this and try to have some patients lose their license. We are aware of some doctors that don't care and will not assess drivers with diabetes, while others that are being very hard-nosed about this and reporting almost 50 percent of their patients.

This is when patients are going to realize that these doctors have done nothing to educate them about diabetes and what to do to manage it more effectively. We have several members of our informal group that are very concerned. They have stated that if it was not for our group, they would have very little education. They have had their doctor ask them continuously about hypoglycemia and how often they have had it. Since only one of them has had one time with hypoglycemia, the doctor is claiming that they 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% and the other 5.7%. The doctor says they all should be above 6.5% and nearer 7.0%. We have all urged them to consider finding a different doctor.

All three are between 56 years and 64 years of age and still working at jobs they love. One has finally found a different doctor and is much happier as the doctor has asked about hypoglycemia and after he explained, he is eating low carb, getting daily exercise, and has not had hypoglycemia or readings below 75 mg/dl. The doctor did download his meter and reviewed the log and said there was no indications of hypoglycemia. His latest A1c was 5.6% and the doctor just told him to continue what he is doing. They did discuss medications and the doctor asked if he wanted to go back to oral medications, but did not go farther when told no.

Most of our group feels that there are some people that are not paying enough attention to their blood glucose levels before driving. One of our group has a type 1 neighbor that has been taken to the hospital several times in the last year for extreme hypoglycemia and still drives. He does wonder if he will continue to have accidents like he has in the neighborhood and still be able to drive.

The section on driving with diabetes on the guidelines is rather lengthy, but has a lot of good information that patients need to understand to avoid problems and not put their driving privileges at risk.

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