A global survey of licensing restrictions for drivers with diabetes


  • Salem A Beshyah Center for Diabetes and Endocrinology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
  • Anas S Beshyah Institute of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
  • Salim Yaghi Institute of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
  • Waleed S Beshyah Institute of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
  • Brian M Frier The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, UK




driving, diabetes mellitus, licensing regulations, insulin, hypoglycaemia, medical fitness to drive


Background: Ensuring medical fitness to drive is an important safety measure for people with diabetes and is a prerequisite for a driving licence in many countries.

Objectives: To ascertain the current regulatory restrictions on drivers with diabetes currently being applied internationally.

Methods: An electronic survey (in English) was sent to contacts of member organisations of the International Diabetes Federation and to selected specialists in diabetes. Questions addressed the regulations in place for insulin-treated drivers.

Results: Information on licensing was obtained from 85 countries. No restrictions on drivers with insulin-treated diabetes existed in 59 countries (69.4%). Medical assessment of some type was required in 29 countries (34.5%). They were performed by different people and at different time intervals. Emphasis was placed on conditions causing potential risk to driving safety. When insulin is introduced to a licensed driver’s treatment, in most countries the driver is permitted to continue driving without any change in licensing entitlement (n=68; 80%); in 16 countries (19%) a driver can retain their driving licence subject to special conditions and in one country the driver will have the driving licence revoked permanently. With respect to large goods vehicles and passenger-carrying vehicles, no restrictions or assessments are required for drivers with insulin-treated diabetes in most responding countries (n=56; 66%); licensing is permitted with some restriction in 23 countries (27%) and prohibited in six countries (7%).

Conclusions: There is a wide variation between different countries and global regions in the statutory requirements and policies used to regulate and assess drivers with diabetes. The lack of regulation in many countries may adversely affect public safety.


World Health Organization. Global status report on road safety 2013: supporting a decade of action. Available at: www.who.int (accessed 30 July 2015).

Graveling AJ, Frier BM. Driving and diabetes: problems, licensing restrictions and recommendations for safe driving. Clin Diabetes Endocrinol 2015;1:8 http://dx.doi.org/10.1186/s40842-015-0007-3

Inkster B, Frier BM. Diabetes and driving. Diabetes Obes Metab 2013;15:775-83. https://doi.org/10.1111/dom.12071

American Diabetes Association, Lorber D, Anderson J, Arent S, et al. Diabetes and driving. Diabetes Care 2012;35(Suppl 1):S81-6. http://dx.doi.org/10.2337/dc12-s081

Cox DJ, Gonder-Frederick L, Clarke W. Driving decrements in type I diabetes during moderate hypoglycemia. Diabetes 1993;42:239-43. https://doi.org/10.2337/diab.42.2.239

Cox DJ, Gonder-Frederick LA, Kovatchev BP, Julian DM, Clarke WL. Progressive hypoglycemia’s impact on driving simulation performance. Occurrence, awareness and correction. Diabetes Care 2000;23:163-70. https://doi.org/10.2337/diacare.23.2.163

Cox DJ, Gonder-Frederick LA, Kovatchev BP, Clarke WL. The metabolic demands of driving for drivers with type 1 diabetes mellitus. Diabetes Metab Res Rev 2002;18:381-5. https://doi.org/10.1002/dmrr.306

DVLA. At a glance guide to the current medical standards of fitness to drive. Drivers Medical Group, DVLA, Swansea, UK. 2014. Available at: www.gov.uk (accessed 30 July 2015).

Road Safety Authority. Medical fitness to drive guidelines. Available at: www.rsa.ie (accessed 30 July 2015).

Austroads. Assessing fitness to drive for commercial and private vehicle drivers. National Transport Commission, Australia. Available at: www.onlinepublications.austroads.com.au (accessed 30 July 2015).

DiaMond Project Group on Social Issues. Global regulations on diabetic treated with insulin and their operation of commercial motor vehicles. BMJ 1993;307(6898):250-3. https://doi.org/10.1136/bmj.307.6898.250

Beshyah SA, Lakhdar AF. Medical aspects of fitness to drive in the developing world: Time to act! Ibnosina J Med BS 2015;7:37-41.

Hassoun AA, Abdella N, Arouj MA, et al. Driving and diabetes mellitus in the Gulf Cooperation Council countries: call for action. Diabetes Res Clin Pract 2015;110:91-4. http://dx.doi.org/10.1016/j.diabres.2015. 08.002

World Bank. World Development Indicators database, 22 July 2016. Available at: http://databank.worldbank.org/data/download/GDP.pdf (accessed 1 August 2016).

World Health Organization. Road traffic death rate by WHO region and income level, 2013. Available at: http://apps.who.int/gho/data/ node.main.A997 (accessed 1 August 2016).

The European Parliament and the Council of the European Union. Directive 2006/126/EC of the European Parliament and of the Council of 20 December 2006 on driving licences. Off J Eur Union 2006;L403:18-60.

The European Parliament and the Council of the European Union. Commission Directive 2009/113/EC of 25 August 2009 amending Directive 2006/126/EC of the European Parliament and of the Council on driving licences. Off J Eur Union 2009;L223:31-5.

Kilpatrick ES, Rigby AS, Warren RE, Atkin SL. Implications of new European Union driving regulations on patients with type 1 diabetes who participated in the Diabetes Control and Complications Trial. Diabet Med 2013;30:616-19. http://dx.doi.org/10.1111/dme.12075

Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Prac 2014;103:137-49.


Jadaan KS, Bener A, Al-Zahrani A. Some aspects of road user behaviour in selected Gulf Countries. J Traffic Med 1993;20:143-8.

Qayed MH. Epidemiology of road traffic accidents in Al- Ahssaa Governorate, Saudi Arabia. Saudi Med J 1998;4:513-19.

Ansari S, Akhdar F, Madoorah M, Mutaery K. Causes and effects of road traffic accidents in Saudi Arabia. Public Health 2000;114:37-9. https://doi.org/10.1016/S0033-3506(00)00306-1

Ofosu JB, Abouammoh AM, Bener A. A study of road traffic accidents in Saudi Arabia. Accid Anal Prev 1988;20:95-101.


Ministry of Interior, Directorate of Traffic, United Arab Emirates. Road Traffic Accident, Statistics Annual Report. UAE: MOI, Directorate of Traffic, 1998.

Jadaan KS. Traffic safety in Gulf countries with special reference in Kuwait. Transport Reviews 1988;8:249-65.


Bener A, Abu-Zidan FM, Bensiali AK, Al-Mulla AAK, Jadaan KS. Strategy to improve road safety in developing countries. Saudi Med J 2003;24:603-08.

Beshyah SA, Beshyah WS, Yaghi S, Beshyah AS, Farooqi MH, Lakhdar AA. Perceptions of health care professionals of medical aspects of driving safety: an electronic survey. Ibnosina J Med BS 2015;7:169-75.

Rapoport MJ, Weegar K, Kadulina Y, et al. An international study of the quality of national-level guidelines on driving with medical illness. QJM 2015;108:859-69. http://dx.doi.org/10.1093/qjmed/hcv038






Original Research