The Association strongly disagrees with the A1C range established by FMCSA in its November 8, 2005 notice. The Association generally recommends people with diabetes try to keep their A1C level below 7%. This is not necessary for safe driving, but in order to lessen the chances of developing the long-term complications of diabetes.29 Yet, anyone who meets this goal would, per the November 8, 2005 notice, be automatically disqualified from commercial driving. FMCSA seems to claim that this range is needed to prevent incapacitating low blood glucose levels. That is not what FMCSA’s own experts – or any expert in diabetes management – would say.30 Rather, the over fifty safety measures in the Diabetes Exemption Program, including providing A1C data as a one of the measures considered, are more than sufficient to determine which people who use insulin are qualified to be safe commercial drivers.31
FMCSA subsequently stated in the application form for those seeking diabetes exemptions that, “applicants with A1c test levels <7% are eligible for an exemption if they have no
history of severe hypoglycemic episodes.”32 its Expert Medical Panel:
The agency further explained in its response to
The A1C range that we referenced in our November 2005 notice of changes to the exemption program is not used as an absolute standard for determining the eligibility of applicants for diabetes exemptions. The range we referenced is for use by endocrinologists in making an individual determination whether the treating physician believes it is appropriate to recommend that the driver be granted a diabetes exemption.33
While the Association is pleased to see FMCSA acknowledge that individuals with an A1C below 7% may be qualified to operate CMVs, this statement does not go far enough. The exemption program specifically defines disqualifying severe hypoglycemic reactions – to include seizure, loss of consciousness, a reaction requiring assistance of another person, or a period of impaired cognitive function that occurred without warning – and thus it is unnecessary to have any further requirement or suggestion of what FMCSA believes is the “acceptable range.” Doing so essentially requires that an individual obtain an exemption within an exemption simply because he or she has achieved the level of blood glucose
29 See id. (stating that “an A1C above 7, while not ideal for long-term health, does not mean that an individual is not a safe driver. While very high A1C readings do raise a concern, we do not support a specific upper cutoff. Rather . . . A1C results should be reviewed with daily blood glucose readings and an assessment made that takes into account the numerous other screening guidelines that are a part of the diabetes exemption program.”).
31 See id. (discussing the role of an individual’s A1C and stating that “this information, taken together with the numerous other screening, operation, and monitoring procedures that we recommended (and that are a part of the diabetes exemption program), established a safe system to select drivers with insulin treated diabetes.”).
32 See “Exemption Application, Diabetes Standard” available at: http://www.fmcsa.dot.gov/documents/safetyprograms/Diabetes/diabetes-exemption-package.pdf (last visited Apr. 28, 2006).
33 Letter from Annette M. Sandberg, Administrator, Federal Motor Carrier Safety Administration, to Michael Brennan, M.D. (Mar. 24, 2006) (on file with author).