Clarification to guidance on patients with type 2 diabetes

Clarification to the guidance contained in the following publication: 

Medical aspects of fitness to drive – A guide for health practitioners

Type 2 diabetes controlled by oral hypoglycaemic agents

Section 4.3 of the Medical aspects of fitness to drive publication guide currently states that individuals being assessed for licence classes 2, 3, 4, or 5 and/or P, V, I, O endorsements are likely to require:

1. An annual medical certificate from a GP, and
2. A regular pattern of shifts with adequate meal breaks, and
3. A satisfactory two-yearly specialist assessment. 

This update is to clarify that:

1. The medical certificate may be from a health practitioner other than a GP eg a nurse practitioner.
2. The frequency a medical certificate is required will depend on the individual’s medical history and glycaemic control e.g. some individuals may require an annual medical certificate while other may require five-yearly medical certificates
3. The two-yearly specialist assessment is not mandatory in all cases, but may be appropriate where specific concerns/issues are identified. The requirement for a two-yearly specialist assessment/referral is at the discretion of the person issuing the medical certificate.
4. The specialist may be a health practitioner other than an endocrinologist or consultant physician specialising in diabetes. For example, a nurse practitioner or clinical nurse specialist working within a diabetes specialist service may also be able to conduct a specialist assessment.

Type 2 diabetes partly or solely controlled by insulin

Section 4.4 of the Medical aspects of fitness to drive publication guide currently states that individuals being assessed for licence classes 2, 3, 4, or 5 and/or P, V, I, O endorsements are likely to require:

1. A six-monthly medical certificate from a GP, and
2. A regular pattern of shifts with adequate meal breaks, and
3. A satisfactory annual specialist review. 

This update is to clarify that:

1. The medical certificate may be from a health practitioner other than a GP eg a nurse practitioner.
2. The frequency a medical certificate is required will depend on the individual’s medical history and glycaemic control and be at least annually.
3. The annual specialist review is not mandatory in all cases, but may be appropriate where specific concerns/issues are identified.  The requirement for an annual specialist review/referral is at the discretion of the person issuing the medical certificate. 
4. The specialist may be a health practitioner other than an endocrinologist or consultant physician specialising in diabetes. For example, a nurse practitioner or clinical nurse specialist working within a diabetes specialist service may also be able to conduct a specialist review.

This means that where the table in section 4 and paragraph two of section 4.4 currently read “A review from a diabetes specialist is necessary…” these can now be read as “A review from a diabetes specialist may be required…”.