The Medical Review Board (MRB) of the U.S. Department of Transportation (DOT) Federal Motor Carrier Safety Administration (FMCSA) was convened November 1, 2006, at DOT, Washington, D.C. in a meeting open to the public.

MRB Members Present:
Kurt Hegmann, MD, Chairperson
Gunnar Andersson, MD
Michael Greenberg, MD, Co-chairperson
Barbara Phillips, MD
Matthew Rizzo, MD

FMCSA Staff:
Larry Minor, Director of the Office of Bus and Truck Standards and Operations
Mary Gunnels, PhD, Chief, Physical Qualifications Division
Ellison Wittels, MD, Senior Medical Consultant
Kaye Kirby, Team Leader, Medical Review MRB
Pearlie Robinson, Co-Leader, Medical Review MRB
Thomas Keane, Chief, Analysis Division
Madeline Boyd, Federal Advisory Committee Act (FACA) Officer

Other FMCSA Staff:
Shashunga Clayton
Teresa Doggett
David Goette
Christine Hydock
Mark Johnson
Mary Mason
Linda Phillips
Frederic Wood

FMCSA Contractors:
Dellaoise Saunders
Veronica Parham-Dudley
Jennifer Duru
Glenna Tinney, Axiom Resource Management, Inc.

Others:
Daniel Lorber, MD, American Diabetes Association, Expert Panel Member on driving with Diabetes Mellitus
Stephen Tregear, DPhil, ECRI
Marie Tiller, PhD, ECRI
John Sheridan, Manila Consulting Group
Laurie Conly, Manila Consulting Group
Maria Soto, Manila Consulting Group
Dave Burns, Manila Consulting Group

Joel Whiteman, Road Ready
Dan Vancil, Road Ready
Gary Moffitt, Road Ready
Ryan Mead, United Parcel Service
Shereen Arent, American Diabetes Association
Katie Hathaway, American Diabetes Association
Henry Jasny, Advocates for Highway/Auto Safety
David Potts, American Trucking Association
Julie Perrot, National Traffic Safety Board
Rafael Marshall, National Traffic Safety Board

Executive Summary

Mr. Larry Minor, Director of the Office of Bus and Truck Standards and Operations called the second public meeting of the MRB to order, noting that he was the designated Federal official for the MRB.

Mr. Thomas Keane described the data sources available to the MRB – the Motor Carrier Management Information System that contains census information on carriers, their owned/leased vehicles and personnel; an Inspection File that includes roadside inspection data; the Enforcement File on high risk carriers; and the Commercial Driver’s License Information System, which provides access to state and local driver records. There are additional data sources within DOT and the Federal Highway Administration.

Dr. Stephen Tregear presented data in response to the four research questions related to crash risk in the diabetic driving population. Literature searches identified more than 3,000 titles, of which only 35 were found to be useful in addressing at least one of the four research questions. A meta-analysis of crash risk from a subset of 13 studies found that drivers with diabetes mellitus appeared to have a 19 percent higher risk of a motor vehicle crash than comparable counterparts without the disorder. Because only one of the studies included in the meta-analysis enrolled commercial motor vehicle (CMV) drivers, it is unclear to what extent this finding can be generalized to this distinct population of drivers. The research showed that there is a serious lack of quality data on diabetes and driver safety, particularly CMV driver safety.

Dr. Daniel Lorber reported for the diabetes expert panel proceeding held in August 2006. The panel’s recommendations were based on the belief that the increased risk described in the evidence report study (19 percent) was not significant enough to justify a general ban on individuals with diabetes mellitus driving commercial vehicles. The panel felt there was no evidence that insulin users presented a risk higher than individuals with diabetes mellitus who do not use insulin, and that the population of individuals who experience episodes of hypoglycemia are a small proportion of all CMV drivers. The panel recommended establishing a CMV expert panel of endocrinologists to provide consulting support to certified medical examiners, who determine whether commercial drivers are physically qualified to drive. During discussion, the MRB expressed appreciation for the panel’s report, but noted that the findings and recommendations were not evidence-based, but derived from the panel members’ professional experience and opinions.

The MRB discussed the research questions in the diabetes evidence report and, by motion and unanimous vote, agreed that individuals with diabetes mellitus are at increased risk for a motor vehicle crash when compared with individuals who do not have diabetes mellitus, and hypoglycemia is an important risk factor for a motor vehicle crash among individuals with diabetes mellitus. The MRB also agreed that there was insufficient evidence to support the premises that treatment-related factors are associated with an increased incidence of severe hypoglycemia among individuals with diabetes mellitus, or that hypoglycemia awareness training is effective in preventing the consequences of hypoglycemia.

Dr. Tregear described the MRB program support structure, which is divided into three phases: the topic refinement process by which FMCSA identifies key research topics, the development of an evidence-based research report by the research team (extensive literature search and analysis of data from relevant studies), and implementation (MRB recommendations).

Dr. Kurt Hegmann led a brief discussion about future research topics, including Schedule II medications, sleep disorders (sleep apnea and narcolepsy), seizure disorders, and cardiovascular disease.

The public did not offer any comments.

Disclaimer: FMCSA considers evidence, expert recommendations, and other data, however, all proposed changes to current standards and guidance (guidelines) will be subject to public-notice-and-comment and regulatory processes.