“If You Bought It, A Truck Brought It.” Why We Should Care About Diabetes’ Impact on the Trucking Industry

Receiving a diagnosis of type 2 diabetes and learning how to manage the disease can be difficult for anyone. But for people with safety-sensitive jobs, such as commercial vehicle (CMV) drivers, a diagnosis of diabetes could potentially be career-ending. The magnitude and scope of type 2 diabetes, as well as obesity, among the CMV driver population is enormous. Approximately 60 – 65% of CMV drivers are overweight/obese, as defined by a Body Mass Index (BMI) ≥ 26, and approximately 18 – 22% of drivers are diabetic¹. Given the enormity of these statistics, these growing “occupational epidemics” stand to threaten the viability of the entire trucking industry, if not adequately addressed.

An estimated 15.5 million trucks operate in the U.S., keeping goods – and commerce – flowing. There’s a common trucking industry adage: “If you bought it, a truck brought it.” Trucks deliver nearly 70 percent of all freight transported each year in our country, accounting for $672 billion in manufactured and retail goods transported by trucks in the U.S. alone.

Being a truck driver is a demanding job, and one that is not conducive to a healthy lifestyle. It requires long hours on the road with limited access to healthy food choices or adequate sleep, and few opportunities to exercise. These factors put truck drivers at heightened risk for developing diabetes – and make it very difficult for them to properly manage diabetes once they are diagnosed. In addition, since many truckers are contracted or independent, they do not have health coverage, which leads to delayed diagnosis and inadequate – or non-existent – disease management.

The traditional approach for diabetes management has involved prescribing certain first-line oral medications, along with diet and exercise, to help people with type 2 diabetes manage the disease. Then, if diabetes is not adequately managed, physicians will prescribe insulin injections. However, as a precaution to help ensure public safety, the U.S. Department of Transportation’s Federal Motor Carrier Safety Administration (FMCSA), which is responsible for regulating the trucking industry, does not permit people receiving insulin injections to obtain (or maintain) certification as a CMV driver. Insulin injections can lead to hypoglycemia – lower than normal blood glucose levels – which can carry serious side effects such as seizures. The FMCSA introduced a Diabetes Exemption Program in 2003, which can permit people with diabetes who use insulin to maintain their trucking certification. But, there has been a fair amount of confusion about the application and decision process for this program.

So, there is a risk that truck drivers might avoid seeking or complying with diabetes treatment, if there’s a potential it might involve insulin and, thus, potentially lead to job loss.

CMV drivers and their physicians should carefully consider the variety of treatment options approved in the last decade that offer glycemic control with a lower risk of hypoglycemia than multiple daily injections of insulin. In fact, diabetes treatment guidelines published by both the American Diabetes Association and the American Association of Clinical Endocrinologists support the use of these medicines as alternatives to insulin.

Another important initiative, FMCSA is spearheading the creation of a National Registry of Certified Medical Examiners, which is intended to produce trained, certified medical examiners who can effectively determine the physical qualifications to operate commercial motor vehicles in interstate commerce, and help provide the specialized care and treatment strategies needed by this patient population.

Last but not least, we need to focus our attention on initiatives that promote overall wellness and healthier lifestyles for CMV drivers. Given the nature of the occupation, this will not be an easy task. However, if we can have some success on this front, all stakeholders will ultimately benefit.

¹ Database Analysis – Road Ready, Inc.

David McKinney, M.D., M.P.H. is with the California Occupational Medical Professionals in Oroville, CA

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