AAFP Presses for Changes in Federal Diabetes Program

Primary Care Physicians Provide Majority of Diabetes Care

December 09, 2015 02:05 pm News Staff

The AAFP has called out the U.S. Department of Transportation (DOT) for the second time in less than six months for its misguided policy related to the Federal Diabetes Exemption Program.

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The program, operated by the Federal Motor Carrier Safety Administration, gives individuals who take insulin to control type 2 diabetes the opportunity to continue to drive commercial motor vehicles while engaged in interstate commerce.

The problem, according to a Dec. 7 letter(2 page PDF) sent to the agency and signed by the AAFP and four other medical specialty organizations, is that the program "does not allow board-certified primary care physicians to examine applicants and complete the evaluation checklist" required by the program.

Rather, the DOT's online guidance(www.fmcsa.dot.gov) about the program states that driver applicants must be examined by a physician who is a board-certified or board-eligible endocrinologist.

That's shortsighted and just plain bad policy, said the AAFP, the American College of Osteopathic Family Physicians, the American College of Osteopathic Internists, the American College of Physicians and the American Osteopathic Association.

Story Highlights
  • The AAFP has called out the U.S. Department of Transportation for the second time in less than six months for its misguided policy related to the Federal Diabetes Exemption Program.
  • The Academy and four other medical specialty groups demanded in a Dec. 7 letter that primary care physicians be allowed to provide exams for commercial interstate drivers who take insulin to control type 2 diabetes.
  • The letter points out that restricting the provision of such exams to board-certified endocrinologists is bad policy given that primary care physicians provide ongoing care to a majority of U.S. patients with the disease.

"We urge you to change the guidance and application to make it clear that applicants may be examined by their board-certified primary care physician rather than require an endocrinologist," said the groups.

They pointed out that although endocrinologists are indeed capable of performing such exams, primary care physicians certainly should be allowed to participate in the program as well. That's because family physicians and their primary care partners are more likely than endocrinologists to manage the care of patients with diabetes.

Additionally, the letter noted, most patients with the disease would have easier access to a board-certified primary care physician than a subspecialist.

The letter writers also took issue with the agency's overall physical qualification standards as they relate to insulin treatment for diabetes.

"The current rule does not reflect the improvements that have been made over the past decade in treating this condition," said the letter. Furthermore, "the existing restriction on commercial motor vehicle drivers using insulin to treat diabetes is overly burdensome for those who are taking appropriate steps to manage their condition."

Although prohibiting the use of insulin by commercial motor vehicle drivers in certain situations -- such as those transporting hazardous substances -- might make sense, the medical groups conceded, "a blanket prohibition does not reflect the most current medical knowledge or practice."

The letter went on to urge the Federal Motor Carrier Safety Administration to re-evaluate existing standards. Doing so would improve agency efforts to ensure public safety and would "help ensure the overall health and well-being of our patients who operate commercial motor vehicles."

The AAFP earlier called attention to the flawed policy in a similar letter(1 page PDF) sent to the same administrative body in July.

On a related note, as part of the standard and ongoing exemption process, a notice in the Oct. 1 Federal Register(www.federalregister.gov) announced the receipt of applications from 52 individuals asking for an exemption from the prohibition against people with insulin-treated diabetes mellitus operating commercial motor vehicles in interstate commerce.

Each patient's name and age is listed in the announcement, along with a brief medical history. And, as noted by the Federal Register, each and every applicant -- whether from California or Maryland or states in between -- was examined and certified eligible by an endocrinologist.

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