New Federal Rule Recognizes FP Role in Treating Diabetes

AAFP Long Fought Regulation That Sent Commercial Drivers to Endocrinologists

September 24, 2018 02:22 pm Scott Wilson

In a significant victory for family medicine, a federal agency has cleared a roadblock that the AAFP has long pointed to as a barrier that keeps transportation workers with diabetes from benefiting from the continuity of care family physicians provide.

[Woman truck driver in a big rig talking on the C.B. radio]

For more than a decade, commercial drivers who require insulin have had only one path to maintaining a commercial driver's license (CDL): getting the signature of an endocrinologist on a form once a year.

That changes Nov. 19, when the Federal Motor Carrier Safety Administration (FMCSA), part of the Department of Transportation, updates a regulation(www.govinfo.gov) to allow other medical professionals -- including family physicians -- to sign the form.

The move is an important modification of an FMCSA rule, in place since 2005, that required drivers of large trucks and buses who are being treated with insulin for diabetes to obtain certification from an endocrinologist that they could continue driving. Without that annual waiver, an insulin-dependent driver was ineligible to stay on the road.

The fix follows steady pressure from the AAFP, which laid out the case for ending the endocrinologist limitation in letters to the FMCSA in July 2015(1 page PDF) and October 2016,(2 page PDF) as well as in a December 2015 letter(2 page PDF) co-signed with the American College of Osteopathic Family Physicians, the American College of Osteopathic Internists, the American College of Physicians and the American Osteopathic Association.

Kevin Wong, M.D., of Jeannette, Pa., one of the AAFP members who had long pushed for a revision, welcomed the new policy.

"We kept on it, and they heard us," Wong told AAFP News.

"We see many more insulin diabetics than endocrinologists do, and we know them the best," he added. "We follow them and know how to be aggressive with them, how to control their risk factors. And we're used to doing paperwork."

The policy that is being changed affected no small number of workers, even as it replaced a previous outright prohibition that any individual with insulin-dependent diabetes be allowed to participate in commercial interstate driving.

Data suggest that the proportion of Americans with diabetes is approaching 10 percent and climbing;(www.bmj.com) of that overall figure, nearly 6 percent have type 1 disease. And at least one report(wellbeingindex.sharecare.com) indicates that transportation workers, already at increased risk for diabetes as a labor sector with one of the highest obesity rates,(www.ncbi.nlm.nih.gov) have a disproportionally high incidence of diabetes.

Wong said some of his CDL-holding patients avoided insulin to steer clear of the rule.(clinical.diabetesjournals.org) "I had (CDL licensees) tell me they wouldn't drive anymore" if they were treated with insulin, he said.

The new regulation, published Sept. 19 in the Federal Register, cites comments that the Academy provided to the FMCSA.

"The American Academy of Family Physicians urged FMCSA to allow applicants to be examined by their family physicians, rather than endocrinologists," the rule notes. "This commenter noted that not all applicants have access to an endocrinologist, and the family physician is more than capable of managing and treating patients with diabetes, as well as completing the forms needed by commercial motor vehicle drivers."

The rule goes on: "FMCSA agrees with the commenters who stated that requiring evaluation by an endocrinologist is burdensome … because of the scarcity of endocrinologists in many regions of our country.”

Wong put it more simply: "We know our patients, and they know us."

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