A 56-year-old male who is a HGV driver and has a 10 year history of type 2 diabetes is seen on annual review. His glycaemic control is poor with a HBA1c of 10.5% on maximal oral hypoglycaemic therapy. You suggest switching to insulin but he refuses to do this as he would lose his HGV licence.
He also refuses to inform the DVLA himself, what is the most appropriate action in this case?
1.Inform his employer that he must stop driving and suggest administrative work
2.Tell his next of kin that they should inform the DVLA that he is no longer fit to drive
3.Continue to review patient in clinic and accept that he continues to drive
4.Discharge him from clinic as there is nothing more that you can do
5.Inform the DVLA even if the patient withholds his consent
In this particular case, the patient has poor glycaemic control but otherwise has no features whatsoever that preclude him from driving such as retinopathy, neuropathy or hypoglycaemic episodes. You cannot therefore force this patient to switch to insulin and neither can you stop him driving. He will continue to regular a medical every three years for his continued HGV licence.