Answer 1 is incorrect. 2% chose this answer, “Advise SJ to stop driving until A1C is under 7%.” Stopping driving based on an elevated A1C or Time in Range not at target is not recommended unless there is a clear safety risk. Hyperglycemia alone, without symptoms or complications, does not justify driving restrictions. Further assessment is needed before recommending driving cessation.¹

Answer 2 is incorrect. 1% of you chose this answer, “Report SJ to the state licensing agency due to hyperglycemia and commercial driving risk.” There is no legal or clinical basis to report SJ at this time. Reporting should occur if it is believed SJ poses a risk to public safety, such as recurrent severe hypoglycemia or functional impairments1 affecting driving ability.

Answer 3 is correct. About 84% of respondents chose this, “Collaborate with SJ to develop an individualized plan focused on driving safety and affordable medication strategies.” Individualized care should be emphasized, particularly in cases where cost limits access to newer therapies. We can explore medication cost saving resources, cost-effective oral agents, titration of basal insulin if not already optimized, or addition of prandial insulin support glycemia. SJ has been driving for many years, ensure driving safety strategies and ensure SJ knows the Federal Motor Carrier Safety Administration rules, which allow individuals with insulin-treated diabetes to drive commercially, as long as safety is maintained.² 

Finally, Answer 4 is incorrect. 13% chose this answer, “SJ would benefit from prandial insulin therapy, recommend switching to a premixed insulin regimen to improve time in range.” Premixed insulin may not be the best option for someone like SJ with an unpredictable schedule. It increases the risk of hypoglycemia and limits flexibility. While it may help improve A1C, other options should be considered first, including more flexible insulin regimens or cost-conscious oral therapies.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!