In 2018 the Department of Transportation (DOT) published a new rule on the requirements for medical certification of commercial motor vehicle (CMV) drivers with insulin-treated diabetes mellitus. This rule eliminates significant obstacles for those drivers, thus potentially enabling thousands of drivers to pursue careers that had previously been unavailable to them.

This poster reviews the process of CMV medical certification for drivers with insulin-treated diabetes and provides resources and guidance for the assessment process. The new rule requires an assessment by a treating clinician (defined as a healthcare professional who manages, and prescribes insulin for, treatment of the individual’s diabetes mellitus as authorized by the healthcare professional’s applicable state licensing authority). The components of this assessment include:

• A minimum of 3 months of blood glucose self-monitoring records measured with a glucometer that stores all readings from which data can be downloaded.

• Hypoglycemia history.

• Hemoglobin A1C measurements.

• Complications of diabetes.

The treating clinician completes an assessment form to determine whether the driver meets the physical qualification standards of the Federal Motor Carrier Safety Administration (FMCSA) to operate a CMV. Additional assessment by the treating clinician may be required if the driver has recently experienced a motor vehicle accident or severe hypoglycemic episode. The treating clinician is required to attest the driver maintains a “stable insulin regimen” and “proper control of his/her diabetes mellitus.” The American Diabetes Association provides a useful online calculator to assess the risk of a diabetes related motor vehicle accident (

Although the rule requires an opinion from a treating clinician, the final decision on medical certification for any individual CMV driver is made by a certified medical examiner listed on the National Registry of Certified Medical Examiners.


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

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