A federal agency, recognizing that primary care physicians are at least as capable as endocrinologists in caring for patients with diabetes, is heeding the AAFP's call in a proposal to expand the pool of clinicians eligible to assess whether a patient who has diabetes can safely work as a commercial driver.
Commercial drivers must apply to the Federal Diabetes Exemption Program to be able to operate a large truck or bus in interstate commerce while they are being treated with insulin. Currently, only board-certified or board-eligible endocrinologists can examine and certify drivers for the program. That would change under a rule proposed by the Federal Motor Carrier Safety Administration -- an agency within the U.S. Department of Transportation (DOT) -- and published in the Sept. 9 Federal Register.(www.gpo.gov) The proposed rule would allow a primary care clinician who has prescribed insulin to the applicant and is knowledgeable about the treatment of diabetes to complete and sign the certification form.
The AAFP, prompted by concerns voiced by the Georgia AFP, wrote to the DOT in July 2015 to urge the agency to include primary care physicians in the list of clinicians who could perform the requisite exam and complete the documentation. The letter noted that about 34 percent of ambulatory care visits to physicians by patients with diabetes were made to family physicians or general practitioners.
The AAFP followed up in December 2015 with a letter signed by the Academy and four other medical specialty organizations to increase pressure on DOT to change the requirements. The letter pointed out that drivers have greater access to board-certified primary care physicians than to endocrinologists.
In a response received on Aug. 25,(1 page PDF) the DOT told the AAFP that it received more than 1,250 comments about the proposed rule, many of which supported the Academy's position.
The proposed rule would maintain the current requirement that drivers seeking exemption also receive an eye exam from an ophthalmologist or optometrist.
The AAFP will offer additional comments on the proposed rule, which are being accepted until Nov. 8.
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American Family Physician: AFP by Topic: Diabetes Type 2