Diabetes is a chronic and potentially debilitating disease that can lead to many types of medical complications, including heart disease, blindness, kidney failure, stroke, and more. More than 37 million people—11.3% of the U.S. population—have diabetes, according to the Centers for Disease Control and Prevention (CDC). Out of those, the American Diabetes Association (ABA) reports that 8.4 million people rely on the drug insulin to control their symptoms.
Per U.S. Department of Transportation (DOT) diabetes regulations, commercial motor vehicle (CMV) operators who are diabetic and are undergoing insulin treated diabetes mellitus (ITDM) are required by the Federal Motor Carrier Safety Administration (FMCSA) to complete the Insulin Treated Diabetes Mellitus Assessment Form. This is also known as form MCSA-5870 or the FMCA diabetes form.
In this blog, we explore the ITDM regulation, the role of form MCSA-5870, tips for timely completion and submission, and best practices for managing ITDM.
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Diabetes mellitus is the most common variation of diabetes. Diabetes mellitus occurs when a person’s pancreas fails to function properly. With diabetes mellitus, the pancreas does not produce enough insulin, leading to a dangerous spike in blood sugar levels and the need for ITDM. A person with diabetes mellitus will most likely be frequently tired and experience blurred vision and, potentially, other even more serious symptoms, including cardiovascular issues, loss of sensation, and more.
The purpose of MCSA-5870 is to ensure that people with ITBM:
Recertification is required every 12 months, meaning that CMV operators must submit to a physical examination and resubmit their MCSA-5870 forms annually.
Any individual with ITBM who wishes to operate a CMV must complete form MCSA-5870. Completion of the form is part of the individual’s CMV physical assessment and, if applicable, becomes part of the applicant’s physical examination record. It must be made available to Certified Medical Examiners (CMEs) to an authorized representative of FMCSA, or an authorized federal, state, or local law enforcement agency representative, within 48 hours after being requested.
Per the FMCSA, anyone who “has recently experienced a severe hypoglycemic episode must complete form MCSA-5870.”
Form MCSA-5870 is a four-page form comprised of several sections, each featuring a series of questions designed to gauge an applicant’s ability to control diabetes and its associated symptoms.
Essentially a DOT insulin waiver, form MCSA-5870 asks individuals to answer the following questions:
See the complete MCSA-5870 form for a full list of questions.
The FMCA diabetes form is completed as part of the individual’s medical certification process to operate a CMV. As such, form MCSA-5870 is filled out by the individual’s treating physician at the point of care. Per the FMCA, upon completion of the form the physician attests “that the individual has a stable insulin regimen and properly controlled diabetes.”
Upon completion, individuals have 45 days to submit their MCSA-5870 form to the Certified Medical Examiner (CME) as determined by Federal Motor Carrier Safety Regulations (FMCRs). Upon receiving the form, the CME will determine if the driver meets the physical qualification standards set forth by the FCMA. If not, the CME will advise the applicant to seek further evaluation or take steps to address their condition.
If the CME deems the individual ready to drive, they will issue a Medical Examiner’s Certificate known as MCSA-5876. This certificate provides proof of certification which is provided to the driver. Certification is kept on file at the office of the CME for no less than three years from the date of the examination.
CMEs are identified based on their professional licensure and scope of practice, which must include the ability to perform physical examinations. CMEs can be advanced practice nurses; chiropractors; physician assistants; doctors of medicine; doctors of osteopathy; and more. They must be versed in the specific physical and mental demands associated with operating a CSV.
More information can be found in the FMCSA Medical Examiner Handbook.
Individuals who complete form MCSA-5870 have 45 days from the time of completion to submit their responses to a CME. Upon receipt of the form, the CME will begin a comprehensive physical examination. The applicant cannot operate a CMV until they are cleared by the CME and issued a Medical Examiner’s Certificate (MCSA-5876).
Submitting the form within that timeframe is very important. Not doing so can result in delaying the applicant’s ability to become a certified CMV. Applicants can also be denied certification altogether.
There are several steps individuals can take to prepare to complete form MCSA-5870, including:
Finally, applicants must understand that information is power and that research can help them better understand what to expect from the MCSA-5870 form and corresponding examinations.
A helpful resource is the ITDM assessment form web page where a copy of the form can be found. Applicants should familiarize themselves with the questions included within the FMCSA diabetes form so that they can better understand the FMCSA’s requirements and what the physician will ask.
Further research about MCSA-5870 is available at the FMCSA’s site, or by perusing the FMCSA Medical Examiner Handbook. Individuals should pay particular attention to Section 1.4.4, entitled “Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870.”
Diabetes mellitus is a chronic, life-long condition that can cause serious symptoms that can impair commercial vehicle drivers and pose risks to both drivers and others on the road. However, diabetes can be controlled—and symptoms managed—through use of insulin via a process known as Insulin Treated Diabetes Mellitus, or ITBM.
Those who wish to become certified commercial vehicle drivers and are undergoing ITBM are required by the FMCSA to submit to a physical examination and complete the Insulin Treated Diabetes Mellitus Assessment Form, also known as form MCSA-5870 or, informally, the FMCA diabetes form. Four pages long, the form is designed to help the FMCSA gauge whether a person being treated for diabetes mellitus is taking their insulin as prescribed and is following a regular therapeutic regimen. It is also intended to help the organization determine whether an applicant’s symptoms are under control or if they will get in the way of the individual being able to safely drive a commercial vehicle.
The form includes a series of questions, including queries on when the applicant began using insulin, how many times per day they test their blood glucose levels, whether they are compliant with blood glucose self-monitoring based on their specific treatment plan, and more. Individuals are asked to provide detailed information about any diabetic complications or target organ damage they may currently have or recently had as a result of diabetes mellitus. Individuals are also asked to attest that they have maintained records indicating they have performed ongoing blood glucose self-monitoring over at least the preceding three months and provide those records for their physician to review.
The applicant has 45 calendar days from the completion of their MCSA-5870 form to submit their answers to a Certified Medical Examiner, or CME. If the CME deems the answers acceptable, they will provide the applicant with a certification indicating that they are allowed to operate a commercial motor vehicle. Applicants cannot drive a CMV before receiving this certification, so delaying sending the completed form to the CME is not advisable (and going past the 45-day mark could result in the applicant being declined for their CMV certification). Every individual who experiences diabetes mellitus and is undergoing ITBM must be recertified annually and, thus, must fill out form MCSA-5870 every 12 months.
Although form MCSA-5870 is relatively short and straightforward, it is still a comprehensive FMCSA diabetes form that requires the individual applying for CMV certification to potentially provide paperwork attesting to their disease status. Fortunately, there are a number of things applicants can do to prepare before they undergo the physical examination, and their physician fills out the form. These include keeping track of their treatment schedule, preparing any supporting paperwork in advance, and downloading a copy of the MCSA-5870 form from the FMCSA’s website.
Acuity International has years of experience helping the Department of Transportation screen employees, including commercial vehicle drivers, for medical conditions that could impair their ability to do their jobs. Our advanced medical solutions—which include a comprehensive suite of workforce health solutions—are customizable to virtually any workforce configuration and need, and are backed by experienced medical professionals located across the United States and throughout the world.
Contact Acuity to learn more about how we can help support the FMCA’s and DoT’s efforts to screen individuals for diabetes mellitus and ensure they are being treated effectively.
