The American Diabetes Association (ADA) applauds the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA) for its new rule permitting individuals with insulin-treated diabetes to be certified to operate commercial motor vehicles in interstate commerce. The new rule, published in the Federal Register yesterday, is the culmination of more than two decades of advocacy by the ADA to change the rules that govern commercial drivers with diabetes.

Since the 1990s, when Congress and FMCSA began studying the feasibility of licensing people who use insulin through waiver and exemption programs, ADA has been pushing for a medically-appropriate system to individually assess people with diabetes. Recognizing the discrimination that results when people are deemed unsafe simply because of how they treat their diabetes, ADA insisted on better, more fair rules. ADA celebrates the achievement of that goal today with FMCSA’s final rule.

FMCSA rules apply to most people who operate commercial motor vehicles – trucks, buses, construction vehicles, delivery vehicles, airport shuttles, etc. – in interstate commerce. In addition, many employers adopted the rule for their own use in evaluating workers, even if those workers were not directly subject to the rule itself. As a result, a rule that categorically excludes people who use insulin means people with diabetes are kept out of many jobs they are otherwise qualified to perform. The old rule contained a blanket exclusion against insulin use regardless of how well a person managed his or her diabetes. In 2003, FMCSA began granting exemptions to individuals who could satisfy safety criteria and wait out a long and cumbersome application process. The application process involved a period of many months during which the individual could not drive a commercial vehicle, often resulting in loss of income.

The new rule allows individuals on a stable insulin regimen to operate commercial vehicles without needing to obtain an exemption from the government. It provides for an appropriate assessment of diabetes by the individual’s treating clinician, followed by examination and certification from a certified medical examiner. “This rule eliminates a longstanding barrier that prevented people with diabetes from fully realizing their potential in the workforce,” said Katie Hathaway, JD, Vice President of Legal Advocacy for the American Diabetes Association. “I’m proud of ADA’s commitment to this issue and to leading the fight for what’s right for people with diabetes. We are so pleased to celebrate this victory alongside those affected by the outdated rule.”

ADA’s advocacy is reflected in the final rule, which draws on data and recommendations presented in the position statement “Diabetes and Driving,” published in ADA’s peer-reviewed journal Diabetes Care, and dozens of public comments filed with FMCSA over the years. “Data show people with diabetes do not pose an unacceptable risk to public safety, and blanket bans based on science and medicine from 1970 are not medically supported,” said Daniel Lorber, MD, FACP, CDE, chair of the National Advocacy Committee, chair of the Diabetes and Driving writing group and member of the FMCSA Diabetes Expert Panel. “Years of work by ADA staff and volunteers to convince FMCSA to change its rule was grounded in the advances in diabetes science and treatment supported by ADA that allowed for individual assessment and mitigation of risk. Once again, the ADA is fulfilling an important part of its mission ‘to improve the lives of all people affected by diabetes’. We are thrilled FMCSA is ending its exemption program not because it doesn’t work, but precisely because it has demonstrated the feasibility of identifying qualified drivers and the safety of putting them on the roads.”

The final rule was posted in the Federal Register on September 19, 2018.

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