A1C Levels for Truck Drivers

I recently saw the following question:

I am a truck driver who was diagnosed with type 2. What is an acceptable level when it comes to the A1C?

My reply:

What level of A1C is "acceptable" depends on who you ask!

According to the American Diabetes Association's Glycemic Targets for Adults With Diabetes, people with diabetes should be to aim for an A1C below 7.0%. The ADA points out that lowering A1C below or around 7.0% has been shown to reduce both microvascular and macrovascular complications. Another organization, the American Association of Clinical Endocrinologists, says the goal should be an A1C at or below 6.5% "for healthy patients without concurrent illness and at low hypoglycemic risk" and above 6.5% for other folks.

The ADA agrees with AACE that the targets should be individualized based on

• Age/life expectancy
• Comorbid conditions
• Diabetes duration
• Hypoglycemia status
• Individual patient considerations
• Known CVD/advanced microvascular complications

so that goals should be more stringent (<6.5%) if there's

• Short diabetes duration
• Long life expectancy
• No significant CVD

and less stringent (<8%) if

• Severe hypoglycemia history
• Limited life expectancy
• Advanced microvascular or macrovascular complications
• Extensive comorbidities
• Long-term diabetes in whom general A1C target difficult to attain

Since you have type 2 diabetes, and if you are not taking insulin or sulfonylurea medications, your risk of hypoglycemia would seem to be fairly low. Therefore, you should be able to get your A1C down below 7.0% and perhaps below 6.5% without risking severe hypos. Of course, discuss your goals with your doctor or diabetes nurse educator!

Notice, the guidelines quoted above say nothing about adjusting A1C goals based on occupation, or the risk of hypoglycemia while on-the-job. For truckers, airplane pilots, and some other occupations, there's always a lingering concern that hypoglycemia with loss of mental functioning could be dangerous or indeed deadly; that's of especial concern for people with diabetes who are taking insulin. Keeping the blood glucose levels from going too low almost always implies having a somewhat higher A1C (and conversely, a low A1C is frequently associated with more episodes of hypoglycemia).

For truck drivers in the United States, there previously was a total ban on driving with a CDL if on insulin. That changed in 2005, so that people using insulin to treat their diabetes have the possibility of getting an exemption that will allow them to drive commercial vehicles in interstate commerce. (See Frequently Asked Questions About Commercial Driver's Licenses for details.)

Hope this helps!