3.3 Medical standards for licensing
Medical requirements for unconditional and conditional licences are outlined in the table below. Health professionals should familiarise themselves with the information in this chapter and the tabulated standards before assessing a person’s fitness to drive.
3.3.1 Diabetes treated by glucose- lowering agents other than insulin for private drivers
Private vehicle drivers treated by glucose- lowering agents other than insulin may generally drive without licence restriction (i.e. on an unconditional licence) but should be required by the driver licensing authority to have five- yearly reviews.
3.3.2 Recommendation and review of conditional licences for commercial vehicle drivers
It is a general requirement that conditional licences for commercial vehicle drivers are issued by the driver licensing authority based on advice from an appropriate medical specialist (endocrinologist or consultant physician specialising in diabetes) and that these drivers are reviewed periodically by the specialist to determine their ongoing fitness to drive (refer to Part A section 4.4. Conditional licences). For commercial drivers receiving insulin treatment, at least three months of blood glucose monitoring records should be reviewed in assessing fitness to drive.
Commercial vehicle drivers treated by glucose- lowering agents other than insulin must have at least an annual review by an appropriate specialist to monitor the progression of their condition. However, in the case of type 2 diabetes managed by metformin alone, ongoing fitness to drive may be assessed by the treating general practitioner by mutual agreement with the specialist. The initial recommendation of a conditional licence must be based on the opinion of an endocrinologist or consultant physician specialising in diabetes.
In areas where access to specialists may be difficult, the driver licensing authority may agree to a process in which:
- initial assessment and advice for the conditional licence is provided by a specialist (endocrinologist or consultant physician specialising in diabetes)
- ongoing periodic review for the conditional licence is provided by the treating general practitioner, with the cooperation of the specialist.
Where appropriate and available, the use of telemedicine technologies such as videoconferencing is encouraged as a means of facilitating access to specialist opinion (refer to Part A section 3.3.5. Role of medical specialists).
Medical standards for licensing – diabetes mellitus Health professionals should familiarise themselves with the information in this chapter and the tabulated standards before assessing a person’s fitness to drive. | ||
|---|---|---|
| Condition | Private standards (Drivers of cars, light rigid vehicles or motorcycles unless carrying public passengers or requiring a dangerous goods driver licence – refer to definition in Table 3) | Commercial standards (Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition in Table 3) |
| Diabetes controlled by diet and exercise alone | Private standards A person with diabetes treated by diet and exercise alone may drive without licence restriction. They should be reviewed by their treating doctor periodically regarding the progression of their diabetes. | Commercial standards A person with diabetes treated by diet and exercise alone may drive without licence restriction. They should he reviewed by their treating doctor periodically regarding the progression of their diabetes. |
Diabetes treated by glucose- lowering agents other than insulin For definition and management of a ‘severe hypoglycaemic event’ refer to section 3.2.1 | Private standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into consideration the nature of the driving task and information provided by the treating doctor on whether the following criteria are met:
For private drivers who do not meet the above criteria, a conditional licence may be considered by the driver licensing authority, taking into account the opinion of an endocrinologist or consultant physician specialising in diabetes and subject to regular specialist review. | Commercial standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into consideration the nature of the driving task and information provided by an endocrinologist or consultant physician specialising in diabetes* on whether the following criteria are met:
* For a commercial driver with type 2 diabetes who is being treated with metformin alone, the annual review for a conditional licence may be undertaken by the driver’s treating doctor upon mutual agreement of the treating doctor, specialist and driver licensing authority. The initial granting of a conditional licence must, however, be based on information provided by the specialist. |
Insulin- treated diabetes (except gestational diabetes) For definition and management of a ‘severe hypoglycaemic event’ refer to section 3.2.1 | Private standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to at least 2-yearly review, taking into consideration the nature of the driving task and information provided by the treating doctor on whether the following criteria are met:
For private drivers who do not meet the above criteria, a conditional licence may be considered by the driver licensing authority, taking into account the opinion of an endocrinologist or consultant physician specialising in diabetes and subject to regular specialist review. | Commercial standards A person is not fit to hold an unconditional licence:
A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into consideration the nature of the driving task and information provided by an endocrinologist or consultant physician specialising in diabetes on whether the following criteria are met:
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IMPORTANT: The medical standards and management guidelines contained in this chapter should be read in conjunction with the general information contained in Part A of this publication. Practitioners should give consideration to the following:
Licensing responsibility
The responsibility for issuing, renewing, suspending or cancelling a person’s driver licence (including a conditional licence) lies ultimately with the driver licensing authority. Licensing decisions are based on a full consideration of relevant factors relating to health and driving performance.
Conditional licences
For a conditional licence to be issued, the health professional must provide to the driver licensing authority details of the medical criteria not met, evidence of the medical criteria met, as well as the proposed conditions and monitoring requirements. The presence of other medical conditions While a person may meet individual disease criteria, concurrent medical conditions may combine to affect fitness to drive – for example, hearing, visual or cognitive impairment (refer to Part A section 2.2.7. Older drivers and age-related changes and section 2.2.8. Multiple medical conditions).
The nature of the driving task
The driver licensing authority will take into consideration the nature of the driving task as well as the medical condition, particularly when granting a conditional licence. For example, the licence status of a farmer requiring a commercial vehicle licence for the occasional use of a heavy vehicle may be quite different from that of an interstate multiple combination vehicle driver. The examining health professional should bear this in mind when examining a person and when providing advice to the driver licensing authority.
Reporting responsibilities
Patients should be made aware of the effects of their condition on driving and should be advised of their legal obligation to notify the driver licensing authority where driving is likely to be affected. The health professional may themselves advise the driver licensing authority as the situation requires (refer to section 3.3 and step 6).
References and further reading
- Second European Working Group on Diabetes and Driving. Diabetes and driving in Europe. (2005).
- Houlden, R. L. et al. Diabetes and Driving: 2015 Canadian Diabetes Association Updated Recommendations for Private and Commercial Drivers. Canadian Journal of Diabetes vol. 39 347–353 (2015).
- American Diabetes Association. Diabetes and driving – position statement. Diabetes Care 37, S97–S103 (2014).
- Charlton, J.L., Di Stefano, M., Dow, J., Rapoport, M.J., O’Neill, D., Odell, M., Darzins, P., & Koppel, S. Influence of chronic Illness on crash involvement of motor vehicle drivers: 3rd edition. Monash University Accident Research Centre Reports 353. Melbourne, Australia: Monash University Accident Research Centre. (2021).
- Skurtveit, S. et al. Road traffic accident risk in patients with diabetes mellitus receiving blood glucose-lowering drugs. Prospective follow-up study. Diabetic Medicine 26, 404–408 (2009).
- Cox, D. J. et al. Driving mishaps among individuals with type 1 diabetes: a prospective study. Diabetes Care 32, 2177–2180 (2009).
- Redelmeier, D. A., Kenshole, A. B. & Ray, J. G. Motor vehicle crashes in diabetic patients with tight glycemic control: a population- based case control analysis. PLoS Medicine 6, (2009).
- Royal Australian College of General Practitioners. Management of type 2 diabetes: a handbook for general practice. (2020).
- Australian Type 1 Diabetes Guidelines Expert Advisory Group. National evidence- based clinical care guidelines for type 1 diabetes in children, adolecents, and adults. (Australian Government Department of Health and Ageing, 2011).
- Clarke, W. L. et al. Reduced awareness of hypoglycemia in adults with IDDM: a prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care 18, 517–522 (1995).
- Høi-Hansen, T., Pedersen-Bjergaard, U. & Thorsteinsson, B. Classification of hypoglycemia awareness in people with type 1 diabetes in clinical practice. Journal of Diabetes and its Complications 24, 392– 397 (2010).
- Geddes, J., Wright, R. J., Zammitt, N. N., Deary, I. J. & Frier, B. M. An evaluation of methods of assessing impaired awareness of hypoglycemia in type 1 diabetes. Diabetes Care 30, 1868–1870 (2007).
- Schopman, J. E., Geddes, J. & Frier, B. M. Prevalence of impaired awareness of hypoglycaemia and frequency of hypoglycaemia in insulin-treated type 2 diabetes. Diabetes Research and Clinical Practice 87, 64–68 (2010).
- Geddes, J., Schopman, J. E., Zammitt, N. N. & Frier, B. M. Prevalence of impaired awareness of hypoglycaemia in adults with type 1 diabetes. Diabetic Medicine 25, 501–504 (2008).