Assessing Fitness to Drive

Table of Contents

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 / 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 the process of assessing fitness to drive.

Commercial vehicle drivers treated by glucose-lowering agents other than insulin are required to have at least 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 / 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 / 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).

Figure 10: Management of diabetes and driving

It is important that health professionals familiarise themselves with both the general information above and the tabulated standards before making an assessment of a person’s fitness to drive.

Medical standards for licensing – Diabetes mellitus
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)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition)

Diabetes controlled by diet and exercise aloneA person with diabetes treated by diet and exercise alone may drive without licence restriction. They should be reviewed by their treating doctor periodically regarding progression of diabetes.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 progression of 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.

A person is not fit to hold an unconditional licence:

  • if the person has end-organ complications that may affect driving, as per this publication; or
  • the person has had a recent ‘severe hypoglycaemic event’.

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:

  • any end-organ effects are satisfactorily treated, with reference to the standards in this publication; and
  • the person is following a treatment regimen that minimises the risk of hypoglycaemia; and
  • the person experiences early warning symptoms (awareness) of hypoglycaemia or has a documented management plan for lack of early warning symptoms; and
  • any recent ‘severe hypoglycaemic event’ has been satisfactorily treated, with reference to the standards in this publication (refer to section 3.2.1).

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 / consultant physician specialising in diabetes and subject to regular specialist review.

A person is not fit to hold an unconditional licence:

  • if the person has non-insulin treated diabetes mellitus and is being treated with glucose- lowering agents other than insulin.

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 / consultant physician specialising in diabetes* on whether the following criteria are met:

  • there is no recent history of a ‘severe hypoglycaemic event’ as assessed by the specialist; and
  • the person experiences early warning symptoms (awareness) of hypoglycaemia; and
  • the person is following a treatment regimen that minimises the risk of hypoglycaemia; and
  • there is an absence of end-organ effects that may affect driving as per this publication.

* 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.

A person is not fit to hold an unconditional licence:

  • if the person has insulin-treated diabetes.

A conditional licence may be considered by the driver licensing authority subject to at least two-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:

  • there is no recent history of a ‘severe hypoglycaemic event’; and
  • the person is following a treatment regimen that minimises the risk of hypoglycaemia; and
  • the person experiences early warning symptoms (awareness) of hypoglycaemia (refer to section 3.2.1) or has a documented management plan for lack of early warning symptoms; and
  • there are no end-organ effects that may affect driving as per this publication.

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 / consultant physician specialising in diabetes and subject to regular specialist review.

A person is not fit to hold an unconditional licence:

  • if the person has insulin-treated diabetes.

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 / consultant physician specialising in diabetes on whether the following criteria are met:

  • there is no recent history (generally at least six weeks) of a ‘severe hypoglycaemic event’ as assessed by the specialist; and
  • the person is following a treatment regimen that minimises the risk of hypoglycaemia; and
  • the person experiences early warning symptoms (awareness) of hypoglycaemia (refer to section 3.2.1); and
  • there are no end-organ effects that may affect driving as per this publication.

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, or reinstating 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 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.

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 Multiple medical conditions and age-related change).

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 3.3.1 and step 6 of the assessment and reporting process).

Patient information

The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia. The NDSS provides information and support services to people with diabetes, including information about driving. Refer to <www.ndss.com.au>.

The ‘Above 5 to Drive’ resources are also available through Diabetes Australia at <www.diabetesaustralia.com.au/driving>.

References and further reading

  1. Monash University Accident Research Centre. Influence of chronic illness on crash involvement of motor vehicle drivers. 2nd edition, November 2010. Available: http://monashuniversity.mobi/muarc/reports/muarc300.html.
  2. Cox DJ, Ford D, Gonder-Frederick L, Clarke W, Mazze R, Weinger K, Ritterband L. Driving mishaps among individuals with type 1 diabetes: a prospective study. Diabetes Care. 2009; 32(12): 2177–2180.
  3. Redelmeier DA, Kenshole AB, Ray JG. Motor vehicle crashes in diabetic patients with tight glycemic control: a population-based case control analysis. PLOS Medicine. 2009; 6(12): e1000192.
  4. Hoi-Hansen T, Pedersen-Bjergaard U, Thorsteinsson B. Classification of hypoglycemia awareness in people with type 1 diabetes in clinical practice. Journal of Diabetes Complications. 2010; 24(6):392–397.
  5. Clarke W, Cox DJ, Gonder-Frederick LA, Julian D, Schlundt D, Polonsky W. Reduced awareness of hypoglycemia in adults with IDDM. Diabetes Care. 1995; 18(4): 517–522.
  6. Geddes J, Wright RJ, Zammitt NN, Deary IJ, Frier BM. An evaluation of methods of assessing impaired awareness of hypoglycaemia in type 1 diabetes. Diabetes Care. 2007; 30(7): 1868–1870.
  7. Royal Australasian College of General Practitioners. General practice management of type 2 diabetes 2014–15. Available: www.racgp.org.au/your-practice/guidelines/diabetes.
  8. National Health and Medical Research Council. National evidence based clinical care guidelines for type 1 diabetes for children, adolescents and adults, 2011. Available: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ext004_type1_diabetes_children_adolescents_adults.pdf.