Belgium requires virtually every driver diagnosed with diabetes to obtain a medically restricted license, while neighboring countries increasingly focus only on those whose condition or treatment creates a real driving risk.
Yet according to the Belgian road safety institute Vias, one in five people with diabetes is driving without the required adapted license. That discrepancy raises a broader question: is Belgium dealing with a compliance problem, or has its diabetes driving law failed to keep pace with modern medicine?
The figure comes from a survey by the Diabetes Liga, l’Association du Diabète, and the Vias Institute among 1,136 people with diabetes who hold a driver’s license. Belgium has around one million people with diabetes.
Insufficiently informed
People with diabetes must monitor this themselves and, after visiting their GP or endocrinologist, register with the municipality, accompanied by a completed certificate of fitness to drive.
Yet most are unaware of this requirement. Quite a few people with diabetes are insufficiently informed about the rules regarding fitness to drive. Some people are unaware that their driver’s license needs to be renewed regularly. In contrast, others only discover years after their diagnosis that they need to apply for a modified driver’s license.
However, anyone driving without a modified driver’s license is legally considered not to hold a valid license. This can result in a fine and have consequences in the event of an accident, even if the accident is unrelated to diabetes. It can also jeopardize insurance coverage.
According to the study, almost 8 out of 10 (78%) of the surveyed people with diabetes hold a modified driver’s license. This means that 22% are not in compliance with this requirement. 18% of the respondents believe that a modified driver’s license for people with diabetes is unnecessary.
Is Belgian law outdated?
The survey reveals a significant gap between legal requirements and the knowledge or practices of people with diabetes. The three aforementioned organizations therefore intend to launch an awareness campaign aimed at people with diabetes and healthcare providers.
However, the entire issue raises questions. Why, for instance, is legislation in other countries much less strict? And did the Belgian legislator actually take into account the evolution of diabetes treatments?
The rules were substantially rewritten in 2010, but sixteen years later, diabetes care looks very different. Is it then normal that legislation literally starts from the principle that a person with diabetes mellitus is “not fit to drive”, before allowing a doctor to declare otherwise?
In all those years, treatment has evolved significantly. A patient treated through lifestyle changes or medication with little hypoglycemia risk is medically very different from an insulin user prone to severe hypos. Yet for the Belgian Category B license, both enter essentially the same five-year medical licensing system.
Other European countries
Across the border, authorities increasingly make that distinction. In the Netherlands, someone using no medication or non-insulin medication does not normally have to report immediately, although diabetes must be declared at the prescribed Health Declaration moments.
France changed its rules explicitly in 2022 to take scientific and technological progress into account. Germany is even more directly risk-based. A driver with well-controlled diabetes taking oral medication with a low hypoglycemia risk is considered fit to drive.
Luxembourg similarly concentrates its restrictions on recurrent severe hypoglycemia and impaired awareness rather than treating every diagnosis identically.
Danger of hypoglycemia
That does not mean diabetes poses no road-safety risk. Research is clear about the danger of hypoglycemia. Controlled driving-simulator experiments have shown that driving performance deteriorates significantly even during relatively mild hypoglycemia. The question is whether every person with the diagnosis should be subject to the same administrative licensing regime.
The Vias survey reveals that Belgium certainly has a compliance problem if 22% of drivers with diabetes are ignoring a legal requirement, but maybe the country also has a legislation problem.
Modern medicine can increasingly distinguish between a driver whose treatment creates virtually no hypoglycemia risk and someone with recurrent severe hypos who genuinely should not be behind the wheel.
Insurance system
The insurance question makes Belgium’s system even more peculiar. If a Belgian driver with well-controlled diabetes drives abroad without having converted his Belgian license, and he causes an accident, the victim is not simply abandoned by the insurer.
Belgian compulsory motor insurance provides cover abroad in accordance with at least the compulsory rules of the country where the crash occurs. But whether the foreign-law exception applies ultimately depends on the specific circumstances and legal interpretation.
