Pre-diabetes on metformin
Had a driver come in that has been put on metformin for “pre-diabetes”, but told she doesn’t have DM (yet).
So on treatment for a “pre” condition. At what point would this be considered for a 1 year card? Starting to see drivers with “pre-“conditions and on medications, e.g., HTN and DM. If the driver is on treatment but does not “have” the disease how are others dealing with this?
Sheesh, pre this and pre that, nobody is normal anymore. And aren’t we all pre-dead?
Medically, with improved diagnostic techniques, it does indeed seem that there will be people who don’t quite meet the current criteria for a disease state (often as defined by the insurance rather than medical community) but are clearly on the path to the condition. Perhaps a way to look at it is that they can make a change in lifestyle or take a medication so that they avoid reaching the standard definition of the disease.
However, I’ve seen situations where the application of “pre” whatever is a ploy by the driver and perhaps their physician to try to avoid having to mark “yes” to the condition. I’ve especially seen it with the issue of seizures. The driver admits they have had seizures but says they don’t have “epilepsy” which would be disqualifying. Their doctors may or may not go along with this.
But, to me at least, for the purposes of certifying the driver and/or the length of the certification, I stick to the basic reason for the exam- is this driver safe to drive a commercial vehicle and if so, how long do I expect them to be stable. So, I sort of ignore the “pre” designation and ignore the “seizure, not epilepsy” issue and look at the basic facts of the person’s medical condition.
If they do not have any of the absolute disqualifiers and have provided necessary information where needed, and are not likely to develop a sudden disabling condition or slide into a disabling disease- I will certify them. The length will depend on how stable they are and the natural history of the disease. As far as I know, here is no regulatory time issue as to how long the driver can be certified except for the 2 year maximum. There are some timeframes that are guidance or commonly used but the time is up to you based on the facts.
For your “pre diabetic”, has their been change from year to year. If they are stable, a 1 year or more might well be appropriate. But if they are having increasing HbA1c year to year, I might go 6 months. Since metformin in itself is not likely to cause hypoglycemia, unless there is a history of such, it might not impact my decision.
In the end “its your signature”. You have to decide what is appropriate relative to certification based on all the facts of the case.
Karl Auerbach MD
Albany , NY
