Prediabetes Screening Among Commercial Motor Vehicle Drivers: Does the Use of the American Diabetes Association’s Type 2 Diabetes Risk Test More Effectually Identify Commercial Motor Vehicle Drivers at Risk of Diabetes Versus Sole Reliance on Glycosuria?

Purpose: To determine whether use of the American Diabetes Association’s Type 2 Diabetes Risk Test is more effective at identifying commercial motor vehicle drivers at risk of diabetes versus current practice of sole reliance on glycosuria.

Background: In the United States, 34 million adults have diabetes of which 21% are undiagnosed. Commercial motor vehicle drivers are twice as likely as the national working population to have diabetes due to multiple occupational related factors. Medical complications from uncontrolled diabetes place both the commercial motor vehicle drivers and the public at heightened risk of collision or accident. Commercial motor vehicle drivers are required to complete periodic fitness for duty physical examinations at least every two years. Current practice relies on glycosuria obtained by urinalysis dip stick. However, glycosuria is not detected on urinalysis dip stick unless the blood sugar level is >180 mg/dL, which is >50 mg/dL above diabetes diagnostic standards, if fasting.

 
Methods: The Iowa Model Revised framework was used to guide design of this quality improvement initiative. Participants underwent their routine fitness for duty physical but also completed the American Diabetes Type 2 Diabetes Risk Test and had a point of care A1C done. Results of the American Diabetes Type 2 Diabetes Risk Test were reviewed by the certified medical examiner and compared to the results of the urine glucose dip. Participants identified as being as risk of diabetes were provided an educational handout from the American Diabetes Association on prediabetes and advised to follow up with their primary care provider for additional evaluation. Quantitative methods were used to compare the screening methods then, point of care A1C was used to evaluate effectiveness of the screening tests.

Results: Chi-square tests and Fisher’s exact tests were used to evaluate association between screening tests and A1C level. Based on 117 participants, both screening tests had a poor diagnostic measure.

Conclusions: Although the American Diabetes Association’s Type 2 Diabetes Risk Test was not an accurate diagnostic measure, it created a discussion pathway with participants about the importance of diabetes screening among commercial motor vehicle drivers.