DOT Medical Guidelines: Diabetes
The Department of Transportation (DOT) Medical Examination is very highly regulated as illness complications can have serious consequences for the driver, the examiner, and the general public. DOT medical guidelines outline the health criteria that commercial vehicle drivers must meet to qualify for certification. One health condition that is closely reviewed by the DOT is diabetes. Individuals with known or suspected diabetes are required to provide specific medical information to the DOT-certifying physician regarding diabetic control. The DOT definition of diabetic control often causes confusion for individuals seeking certification, as well as their employers. The following information provides answers to common questions and clears up misconceptions about diabetes and DOT certification.
The maximum certification for a person with diabetes is one year. According to DOT guidelines, a person with diabetes, whether controlled with diet alone or diet plus medication, must meet the following criteria:
- Maintain a glycosylated hemoglobin (Hemoglobin A1C or “HBA1C”) of 8% or less.
The HBA1C is a measure of the average amount of sugar in the blood over the last 3 months. A normal HBA1C is less than 5.7%. Values between 5.7 and 6.4% are classified as being in the pre-diabetic range. These individuals should be closely monitored. If the level is above 6.4%, then the person is diabetic. The HBA1C correlates very well with end organ (blood vessels, nerves, kidneys, heart, or eyes) damage and therefore is a popular marker for disease control. Red blood cells have a lifespan of about 90 days before they are removed by the spleen. Glucose sticks to the hemoglobin in red blood cells. Therefore, the glycosylated hemoglobin can be a good estimate of the average blood sugar and is much more accurate in assessing diabetic control than a fasting blood sugar that varies from day to day. Obviously, it takes about 3 months for the HBA1C to drop, generally by 1 percentage point. Therefore,
- 3 Consecutive Fasting Glucose Levels of 180 mg/dl or less is also acceptable when a person is showing strong efforts towards glucose control.
An HBA1C level of 5% correlates with a blood sugar level of 90 mg/dl and the value increases by 30 mg/dl for each point above 5%. Hence, a blood sugar of 180 suggests an HBA1C of 8.
- The driver must not have a history of the following:
(a) One or more hypoglycemic episodes in the past 12 months,
or 2 or more occurrences in the past 5 years resulting in:
2. Loss of Consciousness
3. Need for Assistance from another person
4. Period of Confusion
(b) Signs of End Organ Damage:
2. Macular Degeneration
3. Peripheral Neuropathy
4. Congestive Heart Disease
6. Peripheral Vascular Disease
7. Kidney Failure
Prior to 2004, diabetic control for DOT certification was assumed adequate if glucose was absent from the routine urine testing done at the time of examination. Likewise, individuals with sugar in their urine were assumed to be diabetic. Both assumptions are fraught with error, as some diabetics only “spill sugar” when the blood glucose value is very high, and non-diabetics can spill sugar after eating, say, a candy bar. This type of testing is only a spot check, giving “at the moment” information. It is, however, an inexpensive way to screen individuals who have no idea of their health risks. “On many occasions, BarnesCare providers are the first to tell a patient that they are diabetic. In a country where 25.8 million people are diabetic, 7.0 million of them are undiagnosed, and 79 million people are pre-diabetic*, we have to do everything we can to abate this crisis. Diabetes screening also provides an exciting opportunity to promote diet and exercise programs to our workforce,” says Leslie Arroyo Robins, DO, FAAFP, BarnesCare physician.
Diabetic individuals seeking DOT certification must provide current (within six months) diabetic control information to the examining physician. This information should be available as part of routine diabetes care through the individual’s primary care physician. To avoid delays in certification, BarnesCare recommends that individuals meet with their primary care physician in advance of the examination to obtain copies of the required laboratory information, then bring that information to the DOT appointment.
Diabetics who require insulin for control cannot be approved for DOT certification unless they have a waiver. The diabetic waiver application and program details can be found on the Federal Motor Carrier Safety Administration website. The process for obtaining a waiver is cumbersome and only a small number of drivers have received this exemption since the waiver program was instituted in 1996. “These medical guidelines can be quite complex,” says Scott C. Jones, DO, MPH, FAOCOPM, BarnesCare medical director. “The medical team at BarnesCare understands the DOT regulations and their importance in promoting driver health, wellness and public safety. We are always available to answer any questions or concerns you may have.”
*The 2011 National Diabetes Fact Sheet