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poses a safety risk. Thus, no additional assessment of the impact on the health of the driver, separate from the safety assessment described above, should be included in the criteria for individual assessment.

FMCSA should not require that individuals with insulin-treated diabetes manage their diabetes in a certain way in order to receive DOT certification. FMCSA’s focus should be on ensuring that the individuals operating CMVs in interstate commerce are physically qualified to do so, and not whether it is medically advisable for a person with diabetes to follow a specific diabetes management regimen or to have a higher or lower A1C level.23 Rather, that is a decision that, from a medical and legal standpoint, should be made by an individual and his or her physician based on how diabetes affects that person. Simply put, one size does not – and should not – fit all.

Further, FMCSA should not apply more stringent standards to individuals with diabetes than it does to other drivers that it regulates through its FMCSRs because of the presence of a diabetes diagnosis unless such standards are necessary to insure safety. As stated in the recently enacted Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU):

Insulin-treated individuals may not be held by the Secretary to a higher standard of physical qualification in order to operate a commercial motor vehicle in interstate commerce than other individuals applying to operate, or operating, a commercial motor vehicle in interstate commerce; except to the extent that limited operating, monitoring, and medical requirements are deemed medically necessary under regulations issued by the Secretary.24

23 In addition, contrary to the assertion in the comments submitted by the National Transportation Safety Board (Docket No. FMCSA-2005-23151-48 at 2-3), it simply is not the case that a person with insulin-treated diabetes must chose between the immediate threat of incapacitating hypoglycemia and utilizing intensive diabetes management to lessen the possibility of long-term diabetes complications. Rather, as stated by the four world-renowned endocrinologists who comprised the FMCSA’s own expert medical panel, “It is our expert opinion that, in part because of the many new diabetes management tools that are available, some people can be brought very close to normal levels of blood glucose without significant risk of hypoglycemia. Certainly most people can reach a goal of <7% [A1C] without this complication.” Letter from Michael Brennan, George

Grunberger, Edward Horton and Christopher Saudek, members of the Expert Medical

Annette Sandberg, Administrator, Federal Motor Carrier Safety Docket no. FMCSA-2001-9800). The advances in diabetes discussed at length in the Association’s 2001 comments which

Administration (Dec. 20, management that make are attached as Exhibit A

Advisory Panel, to 2005) (available at this possible were and incorporated in

these comments.

As we stated in 2001:

For the commercial operator with insulin-treated diabetes, the medical options available today versus twenty-five years ago are staggering. The 1980s and 1990s witnessed an explosion of advances in diabetes self-management techniques and tools that dramatically reduced the threat of an individual’s incapacitation due to hypoglycemia. Advances in blood glucose monitors, insulin, injection devices, insulin pumps, and self-management education all greatly contribute to improved diabetes self-management.

Comments of the American Diabetes Association, Docket No. FMCSA-2001-9800 (Oct. 1, 2001).

24 Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users § 4129, Pub. L. No. 109- 59, 119 Stat. 1144 (Aug. 10, 2005).

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