WA News Guest Opinion / Editorial Diabetes ‘Fitness to Drive’
Diabetes ‘Fitness to Drive’
Written by Dr Ken Thong
Wednesday, 12 July 2017

Since October 2016, new medical standards for assessing diabetic drivers of commercial and private vehicle drivers have been introduced, replacing standards published in 2012.

What has changed for persons with diabetes

A major welcome change is the removal of requirements for “satisfactory control of diabetes”, defined previously as HbA1c of less than 9.0%. This was a contentious requirement since hypoglycaemia, rather than hyperglycaemia, is the predominant risk to driving in diabetes.

A new questionnaire to help assess lack of hypoglycaemia awareness has also been included in the guidelines.

What hasn’t changed

There remains a similar focus on issues such as hypoglycaemia, hypoglycaemia unawareness, end-organ diabetes complications affecting driving and evaluation of common comorbidities such as sleep apnoea. Categories of patients requiring GP versus diabetes specialist assessment remain unchanged. These are based on the licence category pursued (private versus commercial), type of diabetes treatment used, and whether patients face diabetes issues as above.

Author opinion

These standards for drivers with diabetes, about which I have several concerns, were written in conjunction with the Australian Diabetes Society.

Diabetes is a very prevalent chronic disease so a large number of drivers need to be assessed and reassessed, adding to the personal burden those affected by diabetes face. Licensing diabetes consultations divert substantial healthcare resources, largely unaccounted for.

While the evidence linking medical conditions to road collisions is accumulating, I believe that there is still lack of evidence that any licensing standard prevents such events. My personal observation is that the more conscientious patients who self-report their diabetes to the driving licence authorities are those who are burdened, while we fail to “capture” those who are ultimately involved in collisions.

There are some situations whereby a diabetes specialist assessment is needed for a driving licence assessment. While flowcharts are provided and are easy to refer to, the categorisations are unnecessarily complex. Currently, drivers are categorised as treated with metformin only, other non-insulin agents, or insulin. Since most other diabetes medications beside sulphonylureas and insulin carry a low hypoglycaemia risk, I believe the categories should be simplified to patients on insulin or sulphonylurea treatment, or those who are not.

By Dr Ken Thong, Endocrinologist