3 Diabetes Mellitus - DVLA Assessing Fitness to Drive Guide

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

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The 'Assessing fitness to drive: guide for medical professionals' is produced by the Driver and Vehicle Licensing Agency (DLVA) and is a guide for medical professionals to help them with enquiries from the public about driving with various conditions.

Advice for medical professionals for drivers with diabetes mellitus.

X - Must not drive! - May continue to drive subject to medical advice and/or notifying the DVLA√ - May continue to drive and need not notify the DVLA

Diabetes mellitus

Information sent to drivers

Insulin-treated drivers are sent a detailed letter from the DVLA explaining the licensing requirements and driving responsibilities.

All drivers with diabetes must follow the information provided in 'Information for drivers with diabetes', which includes a notice of when they must contact the DVLA (see Appendix D).

Insulin-treated diabetes

Impaired awareness of hypoglycaemia

The Secretary of State's Honorary Medical Advisory Panel on Driving and Diabetes has defined impaired awareness of hypoglycaemia for Group 1 drivers as 'an inability to detect the onset of hypoglycaemia because of total absence of warning symptoms'. Group 2 drivers must have full awareness of hypoglycaemia.

Severe hypoglycaemia

'Severe' is defined as hypoglycaemia requiring another person's assistance.

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - Must meet the criteria to drive and must notify the DVLA.

All the following criteria must be met for the DVLA to license the person with insulin-treated diabetes for 1, 2 or 3 years:

♦ adequate awareness of hypoglycaemia
♦ no more than 1 episode of severe hypoglycaemia in the preceding 12 months
♦ practises appropriate blood glucose monitoring as defined below
♦ not regarded as a likely risk to the public while driving
♦ meets the visual standards for acuity and visual field (see Chapter 6, visual disorders).

! - Must meet the criteria to drive and must notify the DVLA.

All the following criteria must be met for the DVLA to license the person with insulin-treated diabetes for 1 year (with annual review as indicated last below):

♦ full awareness of hypoglycaemia
♦ no episode of severe hypoglycaemia in the preceding 12 months
♦ practises blood glucose monitoring with the regularity defined below
♦ must use a glucose meter with sufficient memory to store 3 months of readings as detailed below
♦ demonstrates an understanding of the risks of hypoglycaemia
no disqualifying complications of diabetes that would mean a licence being refused or revoked, such as visual field defect (see Chapter 6, visual disorders).

Group 1 recommendations and Group 2 requirements for insulin-treated drivers licensed on review

The Secretary of State's Honorary Medical Advisory Panel on Driving and Diabetes has defined the self-monitoring requirements for licensing as follows.

Group 1 car and motorcycle

  • blood glucose testing no more than 2 hours before the start of the first journey
    and
  • every 2 hours while driving
  • applicants will be asked to sign an undertaking to comply with the directions of the healthcare professionals treating their diabetes and to report any significant change in their condition to the DVLA immediately.

More frequent self-monitoring may be required with any greater risk of hypoglycaemia (physical activity, altered meal routine).

Group 2 bus and lorry

  • regular blood glucose testing – at least twice daily including on days when not driving
    and
  • no more than 2 hours before the start of the first journey
    and
  • every 2 hours while driving

More frequent self-monitoring may be required with any greater risk of hypoglycaemia (physical activity, altered meal routine), in which case a bus or lorry driver may be licensed if they:

  • use one or more glucose meters with memory functions to ensure 3 months of readings that will be available for assessment

How the DVLA checks diabetes management requirements for insulin-treated Group 2 bus and lorry licensing

The DVLA takes the following measures to ensure the requirements are met for licensing of insulin-treated Group 2 bus and lorry drivers:

  • requires the applicant's usual doctor who provides diabetes care to undertake an annual examination including review of the previous 3 months of glucose meter readings
  • arranges an examination to be undertaken every 12 months by an independent consultant specialist in diabetes if the examination by their usual doctor is satisfactory
  • at the examination, the consultant will require sight of blood glucose self-monitoring records for the previous 3 months stored on the memory of a blood glucose meter
  • the license application process cannot start until an applicant's condition has been stable for at least 1 month
  • applicants will be asked to sign an undertaking to comply with the directions of the healthcare professionals treating their diabetes and to report any significant change in their condition to the DVLA immediately

Continuous glucose monitoring systems (CGMS)

Because these systems measure interstitial glucose, drivers must also monitor blood glucose levels as outlined immediately above.

Impaired awareness of hypoglycaemia – 'hypoglycaemia unawareness'

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- Must not drive and must notify the DVLA.

Driving may resume after a clinical report by a GP or consultant diabetes specialist confirms that hypoglycaemia awareness has been regained.

X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Refer to the requirements for insulin-treated diabetes

Diabetes complications

Visual complications – affecting visual acuity or visual field

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - May need to stop driving and notify the DVLA.

Refer to Chapter 6, visual disorders .

X- Must not drive and must notify the DVLA.

The licence will be refused or revoked.

Refer to insulin-treated diabetes and Chapter 6, visual disorders .

Renal complications

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - May need to stop driving and notify the DVLA.

Refer to Chapter 7, renal and respiratory disorders.

! - May need to stop driving and notify the DVLA.

Refer to Chapter 7, renal and respiratory disorders.

Limb complications – including peripheral neuropathy

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Any complication such as peripheral neuropathy that means a driver must meet requirements (such as vehicle adaptations) for disabilities! - May need to stop driving and notify the DVLA. See Appendix F, disabilities and vehicle adaptations.

Limb problems or amputations are of themselves unlikely to prevent driving since they may be assisted by suitable vehicle adaptations. The ability to safely control a vehicle at all times is the essential requirement.

! - May need to stop driving and notify the DVLA. See Appendix F, disabilities and vehicle adaptations.

Limb problems or amputations are of themselves unlikely to prevent driving since they may be assisted by suitable vehicle adaptations. The ability to safely control a vehicle at all times is the essential requirement.

Temporary insulin treatment – including gestational diabetes, post-myocardial infarction

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Trial participants for oral or inhaled insulin are also examples to be included as receiving temporary insulin treatment! - May drive and need not notify the DVLA, provided:

♦ under medical supervision
♦ not advised by clinician as at risk of disabling hypoglycaemia.

! - May continue to drive but must notify the DVLA if:

♦ disabling hypoglycaemia occurs
♦ treatment continues for more than 3 months – or in gestational diabetes, continues for 3 months after delivery.

X- Must notify the DVLA and meet the above standards.

Diabetes treated by medication other than insulin

Severe hypoglycaemia

The Secretary of State's Honorary Medical Advisory Panel on Driving and Diabetes has defined 'severe' as hypoglycaemia requiring another person's assistance.

 Group 1
Car and motorcycle
Group 2
Bus and lorry
Managed by tablets carrying hypoglycaemia risk
Including sulphonylureas and glinides! - May drive and need not notify the DVLA, provided:

♦ no more than 1 episode of severe hypoglycaemia in the last 12 months
♦ if needed, detection of hypoglycaemia is by appropriate blood glucose monitoring at times relevant to driving and clinical factors, including frequency of driving
♦ under regular review.

It may be appropriate to monitor blood glucose depending on a number of factors including frequency and/or duration of driving, in which case monitoring should be carried out at times relevant to driving.

If the above requirements and those set out in Appendix D are met, the DVLA need not be informed.

The DVLA must be notified if clinical information indicates the agency may need to undertake medical enquiries.

! - May drive but must notify the DVLA. All the following criteria must be met for the DVLA to issue a licence for 1, 2 or 3 years:

♦ no episode of severe hypoglycaemia in the last 12 months
♦ full awareness of hypoglycaemia
♦ regular self-monitoring of blood glucose – at least twice daily and at times relevant to driving
♦ demonstrates an understanding of the risks of hypoglycaemia
♦ has no disqualifying complications of diabetes that mean a licence will be refused or revoked, such as visual field defect.

Managed by other medication, including non-insulin injectables
Excluding sulphonylureas and glinides! - May drive and need not notify the DVLA, provided the requirements set out in Appendix D are met and the driver is under regular medical review.

! - May drive but must notify the DVLA if clinical information indicates the agency may need to undertake medical enquiries.

! - May drive but must notify the DVLA. The DVLA may issue a licence if the requirements set out in Appendix D are met and the driver is under regular medical review.

A licence is refused or revoked if relevant disqualifying complications have developed, such as diabetic retinopathy affecting visual acuity or visual fields.

A short-term licence may be issued if diabetes complications have developed but the required medical standards have been met.

Diabetes managed by diet/lifestyle alone

Group 1
Car and motorcycle
Group 2
Bus and lorry
√- May drive and need not notify the DVLA.

X- Must not drive and must notify the DVLA if, for example:

♦ relevant disqualifying complications develop such as diabetic retinopathy affecting visual acuity or visual fields
♦ insulin treatment is required (see the requirements for insulin-treated diabetes).

√- May drive and need not notify the DVLA.

X- Must not drive and must notify the DVLA if, for example:

♦ relevant disqualifying complications develop such as diabetic retinopathy affecting visual acuity or visual fields
♦ insulin treatment is required (see the requirements for insulin-treated diabetes).

Hypoglycaemia due to other causes

Group 1
Car and motorcycle
Group 2
Bus and lorry
X- If there are episodes of severe hypoglycaemia from any cause other than diabetes treatment driving must stop while the liability to episodes remains. Examples include hypoglycaemia post-bariatric surgery or in association with eating disorders, and the restriction applies for both car and motorcycle, and bus and lorry drivers.

Pancreas transplant

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - May drive but must notify the DVLA.

Licensing is on the provision that the patient has no disqualifying condition.

If the patient is on insulin, refer to insulin-treated diabetes.

! - May drive but must notify the DVLA.

Licensing will require individual assessment.

If the patient is on insulin, refer to insulin-treated diabetes.

Islet cell transplantation

Group 1
Car and motorcycle
Group 2
Bus and lorry
! - May drive but must notify the DVLA.

Licensing is on the provision that the patient has no disqualifying condition, and is issued for a term requiring medical review.

If the patient is on insulin, refer to insulin-treated diabetes.

! - May drive but must notify the DVLA.

Licensing will require individual assessment.

If the patient is on insulin, refer to insulin-treated diabetes.

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Author:
DVLA
Peer Reviewer:
DVLA
Document ID:
13214 (v8)
Last Checked:
17 June 2016

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