Can drivers with hypertension (HTN) and diabetes mellitus pass Department of Transportation (D.O.T) certification?

From the Guidelines

Drivers with hypertension (HTN) and diabetes can potentially pass DOT certification, but it depends on how well their conditions are controlled, with the most recent guidelines suggesting a blood pressure target of 130/80 mmHg or lower 1. To pass, drivers with hypertension must maintain blood pressure below this target, while diabetic drivers must demonstrate stable blood sugar control. For diabetes, drivers previously needed waivers if using insulin, but since 2018, insulin-treated diabetes can be certified if the driver provides documentation from their treating clinician showing stable glucose management, no severe hypoglycemic episodes in the past 3 months, and proper monitoring 1. Both conditions require regular medical monitoring and documentation. For hypertension, medications like ACE inhibitors, ARBs, calcium channel blockers, or diuretics are commonly used, while diabetes may be managed with oral medications (metformin, sulfonylureas, SGLT2 inhibitors) or insulin. The DOT's concern is that uncontrolled hypertension increases risk of cardiovascular events, and uncontrolled diabetes can cause hypoglycemia or impaired consciousness while driving, creating safety hazards. Some key points to consider in the evaluation of drivers with diabetes include:

• A history of hypoglycemia does not necessarily disqualify a driver, but rather the evaluation should focus on the cause, circumstances, and likelihood of recurrence of such episodes 1.
• Drivers with a history of severe hypoglycemia may require more frequent monitoring and evaluation to ensure safe driving practices.
• The use of a short questionnaire to identify potentially at-risk drivers can be helpful, asking about episodes of hypoglycemia, loss of consciousness, or other symptoms that may impact driving ability 1. Drivers should work closely with their healthcare providers to optimize treatment before their DOT physical examination, and individual assessment is crucial to determine whether a driver's diabetes poses a safety risk, rather than relying solely on glycosylated hemoglobin levels or other metrics 1.

From the Research

DOT Certification for Drivers with Hypertension and Diabetes

• The provided studies do not directly address the issue of DOT certification for drivers with hypertension and diabetes 2, 3.
• However, the studies suggest that hypertension and diabetes are closely linked, and that managing blood pressure and blood glucose levels is crucial for reducing the risk of cardiovascular disease and other complications 2, 3.
• The study by 2 discusses the treatment of hypertension, including lifestyle modifications and medication, and notes that only 44% of US adults with hypertension have their blood pressure controlled to less than 140/90 mm Hg.
• The study by 3 examines the effects of intensive insulin therapy on the development of hypertension in type 1 diabetes, and finds that intensive therapy reduces the long-term risk of developing hypertension.
• To determine whether drivers with hypertension and diabetes can pass DOT certification, it would be necessary to consider the specific requirements and guidelines for DOT certification, as well as the individual's overall health and ability to safely operate a vehicle.
• There are no research papers provided to assist in answering this question directly, further research would be needed to provide a definitive answer.