DRIVING AND DIABETES

Aim(s) and objective(s)

This guideline aims to provide advice about the legislation in place to ensure medical standards
regarding fitness to drive with diabetes according to the Driver and Vehicle Licensing Agency (DVLA)
as at May 2012

User group
Primary Care
Diabetes Specialist Staff
People with Diabetes

Author(s)

Dr Susan Arnott, Diabetes MCN Lead Clinician

Hannah Innes, Diabetes Specialist Nurse

Guideline

Licence groups
There are two groups of licence holders. Medical standards for fitness to drive differ for each group.

Group 1
ƒ Cars
ƒ Motorcycles

Group 2
ƒ Large goods vehicles (LGV)
ƒ Passenger carrying vehicles (PCV) – category D e.g. buses, minibuses

Informing the Driver and Vehicle Licensing Agency (DVLA)

People with diabetes must inform the DVLA of their diagnosis if they:
ƒ are applying for any form of licence for the first time
ƒ are treated with insulin for more than 3 months (including 3 months after delivery in
gestational diabetes)
ƒ are diagnosed with a complication of diabetes, such as retinopathy (eye problems) or
peripheral neuropathy (nerve damage to legs or feet) irrespective of the treatment
received for diabetes.
ƒ have reduced visual acuity or require laser treatment for retinopathy in both eyes, or in
the remaining eye if they have sight in only one eye.
ƒ have more than one episode of hypoglycaemia within 12 months, requiring third party
assistance.
ƒ develop impaired awareness of hypoglycaemia (difficulty in recognising the warning
symptoms of low blood glucose levels).
 Diabetes and Medication
DVLA Medical Standards of Fitness to Drive
TREATMENT GROUP 1 ENTITLEMENT GROUP 2 ENTITLEMENT
ODL – CAR, M/CYCLE VOC – LGV/PCV
INSULIN - Must have awareness of hypoglycaemia - NO episode of hypoglycaemia
(must have warning symptoms) requiring third party assistance in
- Must NOT have had >1 episode of the previous 12 months
hypoglycaemia requiring third party assistance - Full awareness of hypoglycaemia
in previous 12 months - Regularly monitors blood
- Must be appropriate blood glucose glucose at least twice daily and at
monitoring times relevant to driving using a
- Must NOT be regarded as a likely source of glucose meter with a memory
danger to the public whilst driving i.e. full function
awareness of hypoglycaemia - 3 months of blood glucose
- The visual standards for acuity and visual readings must be available to the
fields must be met independent Consultant
Diabetologist at the annual
examination
- Must demonstrate an
understanding of the risk of
hypoglycaemia
- There must be no debarring
complications of diabetes (see
pg 3)
TEMPORARY - If not advised by their doctor that they are at As for insulin
INSULIN risk of disabling hypoglycaemia and they are
TREATMENT ( e.g. under medical supervision they need not notify
gestational the DVLA
diabetes, post MI,
trial participants)
SULPHONYLUREAS Must not have >1 episode of hypoglycaemia - NO episode of hypoglycaemia
and GLINIDES requiring third party assistance in the previous requiring third party assistance in
12 months. the previous 12 months
It may be appropriate to monitor blood - Full awareness of hypoglycaemia
glucose regularly and at times relevant to - Regularly monitors blood
driving to enable the detection of glucose at least twice daily and at
hypoglycaemia. times relevant to driving using a
Must be under regular medical review glucose meter with a memory
function
- Must demonstrate an
understanding of the risk of
hypoglycaemia
- There must be no debarring
complications of diabetes
(see pg 3)
METFORMIN, - They are under regular medical review - Will be licensed unless they
PIOGLITAZONE, - There are no debarring complications develop relevant disabilities e.g.
GLIPTINS, GLP 1 (see pg 3) retinopathy affecting visual fields
ANALOGUES (non - DVLA does not require notification or acuity
insulin injectables) - Monitor blood glucose regularly
and at times relevant to driving
- Must be under regular medical
review
DIET ALONE There are no debarring complications - There are no debarring
DVLA does not require notification complications (see pg 3)
DVLA does not require notification
 Diabetes complications and driving
(i.e potential debarring complications)

Visual Impairment (retinopathy)

Diabetic retinopathy can affect anyone who has diabetes. It can be asymptomatic until well
advanced. Digital Retinal Screening (annually in Lanarkshire) looks for early signs of retinopathy to
allow for early intervention and prevention of visual loss. However, having retinopathy does not
necessarily mean that the individual has to give up driving. It depends on its effect on visual acuity,
visual field and night vision. People with diabetes must inform the DVLA if they have had laser
treatment to both eyes for retinopathy or to the remaining eye if they only have vision in one eye.

Problems with circulation/ sensation (neuropathy)

People with diabetes must inform the DVLA if they develop peripheral neuropathy that results in
difficulty with the safe control of a vehicle.

Restricted licences
People with Diabetes treated with Insulin will be issued with a license for one, two or three years.
Renewals are supplied free of charge. They should not apply for a licence until their condition has
been stable on treatment for 1 month. They must sign an undertaking to comply with the advice of
the doctor(s) treating the diabetes and report any significant change in their condition immediately
to the DVLA. If the doctor does not advise the individual to stop driving they are legally
entitled to drive under Section 88 of the Road Traffic Act. It is important to fully document
any discussions about their medical fitness to drive in their medical record. If their previous licence
was revoked for medical reasons, then the individual does not have a legal entitlement to drive until
a new licence is issued. The person has the right to appeal any decision made by the DVLA. If the
person refuses to inform the DVLA the doctor has an obligation to do so.

Taxis and private hire vehicles

The DVLA recommends that the Group 2 medical standards should also be applied by Local
Authorities to drivers of taxis and private hire vehicles. It is the Local Authority who has the
responsibility to determine the standard.

Driving under ‘blue light’ conditions

DVLA guidance states that people with insulin-treated diabetes should not drive emergency
vehicles.

Insurance cover
When applying for motor insurance, it is wise to declare a diagnosis of diabetes or any changes in
the condition or its treatment even if not directly asked. Failure to do so may invalidate the cover in
the event of a claim. Failure to notify the DVLA as above may invalidate a motor insurance claim.
 Hypoglycaemia (‘hypo’ - low blood glucose)
Hypoglycaemia is the main hazard when driving and can occur if diabetes is treated with:
• Insulin
• Sulphonylureas (e.g. Glipizide, Gliclazide, Glibenclamide), either alone or in combination with other
agents.
• ‘glinides

To avoid the risk of hypoglycaemia advise:

• do not drive for more than two hours without stopping for a snack
• do not delay or miss a meal or snack
• check blood glucose before and during a journey.

People at risk of hypoglycaemia should always carry some form of glucose (such as a sugary non-
diet drink or glucose tablets) with them and inform any passengers of potential signs of
hypoglycaemia and what action should be taken.

At the first symptom or sign of hypoglycaemia advise:

• stop driving as soon as it is safe to do so.
• do not attempt to drive again for at least 45 minutes or longer if the symptoms have not
disappeared
• take glucose tablets or some other form of fast acting carbohydrate immediately and make it clear
that they are no longer in charge of the vehicle e.g. get out of the car / move in to the passenger
seat
• inform the DVLA

Peer Review and Consultation

Diabetes Team Leaders
Diabetes Specialist Nurses, Dietitians, Podiatrists
Practice Nurse Clinical Guideline Lead
Acute Diabetes Lead Clinician
Consultant Diabetologists
GP clinical guideline representative
Diabetes MCN endorsement

Review Date
This guidance is currently under review by the DVLA. Advice will be updated as soon as their
consultation is completed

References
Driver and Vehicle Licensing Agency (DVLA)
Drivers Medical Group, DVLA, Swansea, SA99 1TU
email: eftd@dvla.gsi.gov.uk
www.dvla.gov.uk
Driver and Vehicle Agency (DVA) in Northern Ireland
www.dvani.gov.uk
Further Reading
www.dvla.gov.uk
Scotland@diabetes.org.uk
careline@diabetes.org.uk
voluntarygroups@diabetes.org.uk
www.diabetes.org.uk/guide to diabetes