Background: The prevalence of diabetes in the United States commercial motor vehicle (CMV) driver population is more than twice that of other adults in the U.S. working population. This population is at high risk for type 2 diabetes and for requiring insulin. With the development of the federal highway system and the dramatic increase in interstate commercial driving, in 1970 the Department of Transportation (DOT) put in place safety regulations that included an absolute blanket ban on insulin use. The impact of these regulations for CMV drivers with diabetes was to eliminate an entire career path or choose to avoid insulin with the resulting increased hyperglycemia and long-term sequelae of uncontrolled diabetes.

Interventions: In response to this blanket ban, the American Diabetes Association (ADA), including representation from its advocacy and scientific and medical arms began a strategy of multi-year, multi-disciplinary interventions to address and reverse the blanket ban. From “grassroots” to “grasstops” advocates, every level of the ADA lobbied for this important change. Two diabetes expert panels reviewed relevant data and provided recommendations to both Congress and the DOT. In 2010 ADA convened an expert panel to develop a position statement on Diabetes and Driving. It was necessary for ADA to overcome objections from both a DOT medical review board and other interested parties. The process was characterized by ever-changing obstacles requiring ADA to stay the course for over a decade.

Results: In 2018 the DOT published a new rule on diabetes eliminating the ban against insulin use and simplifying the process of CMV licensure for thousands of insulin-treated drivers.

Conclusions: The ADA’s unique structure and position enabled it to take the lead in dramatically improving the lives of CMV drivers with diabetes. This achievement provides a model for future interdisciplinary collaboration to overcome barriers to employment for people with diabetes.


D. Lorber: None. K. Hathaway: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at