Diabetes
American Diabetes Association Values
A1c and level of control:
Controlled= 6% to 6.9%
Uncontrolled= 7% to 8.9%
Critically high= over 9%
FMCSA recommendation:
- Individuals with a critically high A1c be certified for 3 months.
- Consider consecutive 3-month intervals if the A1c remains high but the individual demonstrates improvement.
HbA1c & estimated Average Glucose (eAG)
| HbA1c | estimated Average Glucose (eAG) |
| 6% | 126mg/dl |
| 6.5% | 140mg/dl |
| 7% | 154mg/dl |
| 7.5% | 169mg/dl |
| 8% | 183mg/dl |
| 8.5% | 197mg/dl |
| 9% | 212mg/dl |
| 9.5% | 226mg/dl |
| 10% | 240mg/dl |
Electronic Glucometer Specifications
- Must store all readings
- Record the date and time of the readings
- Allow for data to be electronically downloaded
Non-Insulin-Treated Diabetes Mellitus
- Commonly referred to as Type II (2) Diabetes, although type 2 diabetics may also need to be treated with insulin
- FMSCA does not specify acceptable levels of glycosuria or glycemia.
- The American Diabetes Association considers a HbA1c greater than 9% to be critically high.
- Glycosuria (400-500mg/dl) may indicate poor control.
- If present, you may elect to order a blood glucose test or a glycosylated hemoglobin (HbA1c).
- You also may consider issuing a 3-month certification.
When an individual presents with severely uncontrolled diabetes, the examiner may consider a 3-month certification
Page 75 of the FMCSA hanbook states, “…an ME may certify an individual with non-insulin-treated diabetes mellitus for up to 24 months if the non-insulin-treated diabetes is well controlled.”
Non-Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5872)This is a voluntary form that MEs may find helpful in determining whether the individual has any medical conditions or symptoms that may prevent them from meeting the qualification standards.
The form requests additional information from the treating clinician regarding the diagnosis, monitoring, and stability of their diabetes by asking questions regarding glucose control, hypoglycemic episodes, recent HbA1c, and organ damage.
Download the Non-Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5872)
Insulin-Treated Diabetes Mellitus: Driver Requirements
- Insulin-treated diabetes mellitus is commonly referred to as Type I (1) diabetes although individuals with type 2 diabetes may also be treated with insulin
- FMSCA does not specify acceptable levels of glycosuria or glycemia.
- The American Diabetes Association considers a HbA1c greater than 9% to be uncontrolled.
- Glycosuria (400-500mg/dl) may indicate poor control.
- If present, you may elect to order a blood glucose test or a glycosylated hemoglobin (HbA1c).
- You also may consider isuing a 3-month certification.
- When an individual presents with uncontrolled diabetes, the examiner may consider a 3-month certification
- Insulin-Treated drivers must have an evaluation by the treating clinician (TC) before any medical examination by the certified ME
- Driver must provide the TC with at least the preceding 3 months of electronic self-monitoring records while being treated with insulin
- The frequency of monitoring should be determined by the TC
- The driver can provide either the glucometer or a printout
- If the driver DOES NOT have the preceding 3 months of self-monitoring records while on insulin, they may only be certified for 3 months
- Upon return, if 3 months of compliant self-monitoring records are provided to the TC, a new ITDM Assessment Form (MCSA-5870) can be completed by the TC
- Insulin-treated individuals cannot have either severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy
Insulin-Treated Diabetes Mellitus: Treating Clinician Requirements
The treating clinician (TC) must complete the Insulin-Treated Diabetes Mellitus Assessment Form (MCSA-5870) before any medical examination by the ME
- The TC attests on the form that the individual maintains a stable insulin regimen and proper control of their diabetes
- They sign and date the form and provide their business information
Insulin-Treated Diabetes Mellitus: Medical Examiner Requirements
The ME must receive the completed form MCSA-5870 no later than 45 days after it has been completed. This is the case for each medical examination.
Upon receipt of a valid form:
- The examination is performed
- The ME considers the information provided and determines whether the individual meets the qualification standards
- If the standards are met, the ME may issue a Medical Examiner’s Certificate for up to a maximum of 12 months
Severe Hypoglycemic Episode
Key Insights:
- An episode that either required the assistance of others OR resulted in a seizure, loss of consciousness, or coma
An ITDM driver who experiences a severe hypoglycemic episode is prohibited from operating a CMV.
- The individual must report the episode
- They must be evaluated by their treating clinician as soon as is practicable
- Once the cause has been addressed, they must again have a stable insulin regimen and properly controlled ITDM
- A new ITDM Assessment Form bust be completed before they can resume operating a CMV
- They must retain the form and present it at their next medical examination