The Driver and Vehicle Licensing Agency (DVLA) published new standards for drivers who have diabetes mellitus a little over a year ago,1 allowing people with diabetes to drive group 2 vehicles (buses and lorries) for the first time in certain circumstances. Drivers who take insulin are still not allowed to drive emergency vehicles.
It is drivers' responsibility to keep the DVLA informed of their diabetic status and how it affects their ability to drive, but GPs need to be aware of the latest standards and their legal and ethical responsibilities.
Group 2 vehicles
Drivers on insulin or oral medication that can induce hypoglycaemia can drive a group 2 vehicle provided they:
- Have had no episodes of hypoglycaemia requiring the assistance of another person in the past 12 months.
- Have full hypoglycaemic awareness (that is, are able to avoid the onset of hypoglycaemia by taking action after warning symptoms).
- Can demonstrate regular blood glucose monitoring at least twice daily with a meter with memory function.
- Have no other debarring complications of diabetes, such as eye problems.
The DVLA will arrange annual review by an independent diabetic consultant, who must examine three months of blood sugar readings, which the patient collects on a blood glucose meter.
If patients change from oral hypoglycaemics to insulin, they must tell the DVLA and stop driving group 2 vehicles.2
Group 1 vehicles
Drivers must inform the DVLA if they are taking insulin. Drivers of group 1 vehicles (cars and motorbikes) using insulin must have an awareness of hypoglycaemia, have adequate blood glucose monitoring, not be a danger to the public and meet eyesight standards.
Patients must inform the DVLA if they have had more than one episode of hypoglycaemia requiring assistance from another person in a year. You should advise patients not to drive if they have had an episode requiring admission to A&E, treatment by paramedics, or assistance from a partner/friend who had to administer glucagon/glucose because the patient could not do this.
The patient does not have to report an episode of hypoglycaemia if they were conscious of it and able to take appropriate action independently.
Patients taking insulin temporarily (less than three months), for example due to gestational diabetes, need not inform the DVLA as long as they are under medical supervision and not at risk of disabling hypoglycaemia.
|MDU advice to GPs|
Be aware of the latest guidance from the DVLA about drivers with diabetes.
If you are concerned that a patient with diabetes is driving against DVLA advice, you should follow GMC guidance as set out above.
If the patient is awaiting a second opinion as to whether they can safely continue to drive, advise them not to drive in the meantime.
Complications of diabetes
Drivers must inform the DVLA if they have the following complications:
- Requirement for laser or anti-VEGF treatment to both eyes, or the remaining eye if the patient has sight in one eye only.
- Problems with vision in both eyes, or in the remaining eye if they have sight in one eye only.
- Development of any circulatory problems or sensation in the legs or feet which make it necessary to drive certain types of vehicles only, for example, automatic vehicles or those with a hand-operated accelerator or brake.
- Any existing condition that worsens and may affect the patient's ability to drive.
Confidentiality is central to the trust between doctors and patients but can be breached in certain circumstances,3 including disclosures to the DVLA. You should explain to patients that they have a condition which might affect their driving and they should inform the DVLA.4
If patients refuse to accept this, you may wish to obtain a second opinion. You should tell the patient not to drive while awaiting the appointment. If the patient still refuses to inform the DVLA, you should follow GMC guidance as outlined below.
Make every attempt to persuade them to stop driving. You should involve the patient's family in these attempts, if the patient agrees. Tell the patient you will need to inform the DVLA if they continue to drive. Inform the DVLA medical adviser in confidence. Finally, tell the patient in writing that you have disclosed the information to the DVLA.
In most cases, patients will follow medical advice and inform the DVLA, but if you are concerned that this is not happening, you should contact your medical defence organisation for further advice.
- Dr Chu is a medico-legal adviser at the MDU
1. DVLA at a glance guide to the current medical guidelines (for medical professionals). May 2012. www.dft.gov.uk/dvla/medical/aag.aspx
2. DVLA. Group 2 (LGV/PCV) drivers with diabetes mellitus who switch from tablets to insulin. www.dft.gov.uk/dvla/medical/
3. GMC. Confidentiality. 2009. www.gmc-uk.org/guidance/ethical_ guidance/confidentiality.asp
4. GMC. Confidentiality: reporting concerns about patients to the DVLA or the DVA. 2009.www.gmc-uk.org/ Confidentiality_reporting_concerns_DVLA_2009.pdf_27494214.pdf