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Similar problems are attendant in using the Clarke study to oppose lifting the blanket ban on commercial drivers who use insulin. Use of this study, as a gauge for whether or not there should be an exemption program for commercial operators, particularly one that has a strictly defined protocol with accountability mechanisms, is misleading at best.

Proponents of using the Clarke study to deny individual evaluation to drivers who use insulin fail to consider that:

  • None of the participants in the Clarke study were given a thorough medical screening by an endocrinologist who certified that the applicant both had been educated in diabetes management and had the ability and demonstrated willingness to properly monitor and manage his or her diabetes, as would be participants in the proposed exemption program.

  • None of the participants in the Clarke study had to follow a protocol to regularly monitor their blood glucose while operating a vehicle, as in the proposed exemption program.

  • None of the participants in the Clarke study had to submit to long-term accountability measures, including ongoing education in diabetes management and hypoglycemia awareness, as in the proposed exemption program.

  • None of the participants in the Clarke study were professional drivers, as would be every participant the proposed exemption program.

In sum, using the Clarke study to corroborate a position against the proposed exemption program is fallacious because it extrapolates a conclusion for one population (medically- screened commercial drivers with insulin-treated diabetes subject to operational guidelines and accountability measures) from the actions of a very different population (the general public with type 1 diabetes).

The argument that Clarke’s driving simulator study is applicable is also specious because of the conditions under which data was obtained. Individuals enrolled in the study were quite aware that they were at no personal risk for continuing to drive under artificial conditions of hypoglycemia. None of those citing this study can demonstrate translation of this laboratory observation to real life.

In fact, the Clarke study itself cautions against the type of conclusions that were reached by those opposing individual assessment of commercial drivers with insulin-treated diabetes:

These data should not be construed to mean that individuals with type 1 diabetes should not be permitted to drive or that their privilege to drive should be restricted. Indeed, the frequency of motor vehicle crashes is not known to be higher among drivers with type 1 diabetes.

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