ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, September 1, 1996 TAG: 9608300077
SECTION: BUSINESS PAGE: 1 EDITION: METRO
COLUMN: Trucking
SOURCE: GREG EDWARDS
Should diabetics who take insulin to control the disease be allowed to drive big commercial trucks over the nation's roads?
Under current federal regulations insulin-dependent diabetics are not allowed to operate commercial vehicles in interstate commerce. Diabetics who take insulin are susceptible to episodes of hypoglycemia or low blood sugar, which can cause mental impairment and a driver to lose control of a vehicle.
Some states, however, including Virginia, allow insulin-dependent diabetics to drive commercially within their borders, if they can show through a medical evaluation that they have their diabetes under control. Virginia does not allow those diabetics to operate vehicles that carry passengers or hazardous materials, however.
Other medical conditions that can prevent drivers a commercial license are poor vision, epilepsy and loss of certain limbs. But the issue of diabetes and commercial trucking was raised by a recent call from the owner of a small, local trucking company who was worried about losing drivers because of their diabetes.
According to the American Diabetes Association in Alexandria, 16 million Americans - roughly 6 percent of the population - have diabetes with the majority of them having developed the disease after the age of 40. Some of those people are bound to be truck drivers.
Joe LaMountain, manager of government relations for the ADA, said the association has been trying since the early 1980s to get the Federal Highway Administration to change its blanket policy of denying commercial drivers licenses to all insulin-dependent diabetics.
Hopes were raised in 1993, when the government issued waivers to some diabetics with good driving records and undertook a study of whether they would pose a threat to highway safety. Insurance industry trade groups challenged the waivers in federal court, however, and a judge ruled the FHWA couldn't prove the waiver program was consistent with safe trucking.
The 116 drivers who had been granted waivers were allowed to keep them but no new ones have been given since. LaMountain said the association has given up on the courts and now plans to seek congressional legislation to overturn the government's blanket policy on diabetic drivers, a policy the association believes discriminates against diabetics as a group.
Many people have an outdated idea of what diabetes is, LaMountain said. The policy regarding truck drivers goes back to the 1950s, but a lot has changed since then in the ability of people to control the condition, he said. With the advent of personal blood glucose monitors, diabetics today have much better control of their disease, he said.
The association is not saying all diabetics who want them should be granted commercial licenses, LaMountain said. "In some circumstances people definitely shouldn't be on the road," he said.
But there are people who can control their diabetes and are not a risk, who are losing their driving jobs because of government policy, LaMountain said. He said he fields as many as five calls a week from drivers who have lost their jobs because of current policy.
Because of the threat of job loss many drivers whose diabetes has developed to the point that they need insulin are not taking it, LaMountain said. "You're making people choose between their health and their job," he said.
Dr. James Bailey III, a Roanoke endocrinologist, said he has seen people do just that, put a priority on keeping their jobs when they were faced with the choice of going on insulin. "It's a problem and it's frustrating," he said.
But commercial drivers may actually be in a better position to control their diabetes than diabetics driving personal automobiles, according to the Canadian Diabetes Association. That's because their work schedules may allow for better long-term planning. Also, commercial drivers may be more responsible in controlling their diabetes because their livelihood depends on it, the Canadian group said.
The long hours of commercial drivers and physical stress of unloading trucks could lead to more frequent hypoglycemic episodes but that risk could be reduced by proper training and scheduling, the association said.
Roanoke area managers of trucking companies besides the caller, said they were aware of the diabetes issue but none who were contacted said it had posed significant problems.
Larry Branham is vice president of personnel for giant Overnite Transportation Co. of Richmond, which employs roughly 6,000 drivers. Branham said Overnite has lost some drivers over the years to the diabetes rule.
Branham said he was aware of efforts being made to change the rule, but said Overnite hasn't taken a position on the issue.
The Insurance Institute for Highway Safety, an Arlington-based group supported by insurance companies and trade associations, opposes reversing the federal rule denying commercial drivers licenses to insulin-treated diabetics. In a letter to the Federal Highway Administration in 1992 in response to the proposed experimental waiver program, Allen Williams, senior vice president of the institute cited "new evidence" that doctors couldn't reliably identify in advance most people who would experience a severe episode of low blood sugar. He also questioned the accuracy of self-test devices for blood sugar.
The FHWA proposal was placing the public "at an unacceptable and utterly unnecessary risk of crash injury and death," Williams said. Referring to the FHWA's own studies, he noted that diabetic drivers, even with screening for their potential for severe hypoglycemia, would have a crash rate twice that of nondiabetic drivers.
But Bailey, the Roanoke physician, believes that some insulin-treated diabetics should be able to safely operate commercial vehicles as long as they follow their prescribed treatment. That wouldn't be true for everyone, though, he said, and among those who possibly should be excluded are those who can't recognize the onset of a hypoglycemic reaction.
"The long and short of it is, I think it can be done safely," he said.
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