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Advice for medical professionals to follow when assessing drivers with diabetes mellitus.
Insulin-treated drivers are sent a detailed letter from DVLA explaining the licensing requirements and driving responsibilities (see the INF294 leaflet in Appendix D).
All drivers with diabetes must follow the information provided in ‘Information for drivers with diabetes’, which includes a notice of when they must contact DVLA (see Appendix D).
The Secretary of State’s Honorary Medical Advisory Panel on Driving and Diabetes has defined adequate awareness of hypoglycaemia as whether ‘the licence holder/applicant [is] capable of bringing their vehicle to a safe controlled stop’.
This is a matter of professional judgement and as a guide the duration of hypoglycaemic symptoms experienced should be compatible with bringing a vehicle to a safe controlled stop.
The reliance on alarms on glucose monitoring devices are not accepted as a substitute for adequate symptomatic or physiological awareness of hypoglycaemia experienced by the driver.
Should a driver become reliant on these alarms to advise them that they are hypoglycaemic they must stop driving and notify DVLA.
The Panel has also defined impaired awareness of hypoglycaemia for Group 1 drivers as ‘an inability to detect the onset of hypoglycaemia because of total absence of warning symptoms’.
Group 2 drivers must have full awareness of hypoglycaemia.
The law defines ‘severe’ as an episode of hypoglycaemia requiring the assistance of another person.
Group 1 drivers – episodes of hypoglycaemia occurring during established sleep are no longer considered relevant for licensing purposes, unless there are concerns regarding their hypoglycaemia awareness.
Group 2 drivers – must report all episodes of severe hypoglycaemia requiring the assistance of another person, including sleep episodes.
These devices are more widely known as flash glucose monitoring systems (Flash GM) and real-time continuous glucose monitoring systems (RT-CGM).
These systems may be used for monitoring glucose at times relevant to driving Group 1 vehicles. Users of these systems must carry finger prick capillary glucose testing equipment for driving purposes as there are times when a confirmatory finger prick blood glucose level is required.
If using an interstitial fluid continuous glucose monitoring system (Flash GM or RT-CGM), the blood glucose level must be confirmed with a finger prick blood glucose reading in the following circumstances:
There is a legal requirement for Group 2 drivers to monitor their blood glucose for the purpose of Group 2 driving.
Flash GM and RT-CGM interstitial fluid glucose monitoring systems are not permitted for the purposes of Group 2 driving and licensing.
Group 2 drivers who use these devices must continue to monitor finger prick capillary blood glucose levels with the regularity defined below.
The Secretary of State’s Honorary Medical Advisory Panel on Driving and Diabetes has defined the glucose self-monitoring requirements for licensing as follows.
More frequent self-monitoring may be required with any greater risk of hypoglycaemia (physical activity, altered meal routine).
More frequent self-monitoring may be required with any greater risk of hypoglycaemia (physical activity, altered meal routine), in which case a bus or lorry driver may be licensed if they:
DVLA takes the following measures to ensure the requirements are met for licensing of insulin-treated Group 2 bus and lorry drivers:
✘- Must not drive and must notify DVLA.
DVLA will then carry out medical enquiries before a licensing decision is made.
✘- Must not drive and must notify DVLA following all episodes of severe hypoglycaemia.
All Group 1 and Group 2 drivers who experience an episode of severe hypoglycaemia whilst driving must not drive and must notify DVLA.
The law defines ‘severe’ as an episode of hypoglycaemia requiring the assistance of another person.
All Group 1 and Group 2 drivers who experience an episode of severe hypoglycaemia whilst driving must not drive and must notify DVLA.
Examples include hypoglycaemia post-bariatric surgery or in association with eating disorders, and the restriction applies for both car and motorcycle, and bus and lorry drivers.
The law defines ‘severe’ as an episode of hypoglycaemia requiring the assistance of another person.
✘- If there are episodes of severe hypoglycaemia from any cause other than diabetes treatment driving must stop and the driver must notify DVLA
More frequent self-monitoring may be required with any greater risk of hypoglycaemia (physical activity, altered meal routine).
More frequent self-monitoring may be required with any greater risk of hypoglycaemia (physical activity, altered meal routine).
Seizures provoked by hypoglycaemia now require a period off driving due to the prospective risk of a further seizure.
Clarification of medical standard for diabetes managed by medication other than insulin Clarification of medical standard for severe hypoglycaemia due to causes other than diabetes management
Clarification regarding blood glucose reading requirements for Group 2 licensing when insulin treatment is first notified Clarification of medical standards for hypoglycaemia due to causes other than insulin treatment
Confirmation of the need for physiological hypoglycaemic awareness when using Continuous Glucose Monitoring (CGM) devices. Clarification of the required frequency of examination with the applicant’s usual doctor in the case of Group 2 drivers receiving insulin treatment.
Introduction of guidance for the use of continuous glucose monitoring systems for Group 1 driving. Advice regarding severe hypoglycaemia occurring whilst driving.
Clarification of asleep/awake severe hypoglycaemia and relevant timescales of episodes. Clarification of use of CGMS.
As a consequence of changes in European legislation amendments have been required to the applicable standards for: diabetes mellitus managed by insulin; and diabetes mellitus managed by medication which has a risk of causing hypoglycaemia (low blood sugar).
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First published.
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