Clare Forshaw
Professional Head of Health and Wellbeing, RSSB
Imagine this: you’re a freight train driver with a 9-hour shift ahead of you. You’ll get a 45-minute break halfway through, but you’ll need two by then. That’s because you’ve got type 1 diabetes and every 2 hours you need to do a finger-prick test to get a real-time snapshot of your blood sugar levels. But, you can’t simply stop your train to take the test when you need to, nor can you skip it altogether.
You don’t have this problem outside of work because you use an advanced Continuous Glucose Monitor (CGM) — you have done so for years. This nifty bit of wearable technology tracks sugar levels in real time, 24 hours a day, without the need for routine finger-prick tests. It’s been a game changer in your personal life, reducing the burden of this chronic condition and offering greater freedom and control. If only you could use a CGM at work as well.
In July 2025, RSSB released new guidance and a medical risk assessment approach to address the knowledge gap in industry regarding the safe integration of CGMs. The industry had long relied on the traditional finger-prick method, which frequently resulted in diabetic train drivers being removed from certain routes or, in some cases, their role entirely. The effect on staff morale and operational performance was noticeable. The absence of this more advanced medical technology also stood in stark contrast to the industry’s aspirations to embrace innovation.
Over the past 6 months, train driver managers, safety managers, and occupational health professionals have reported to RSSB the positive impact of the new guidance, with more diabetic train drivers able to work safely. Gareth Jones, Safety Operations Standards Competence Manager, Transport for Wales, said: ‘This work highlights the enhancement of technology, supporting medical conditions previously considered a no-no on the railway.’
Yet, the overarching message extends far beyond just CGMs or even the specific needs of safety-critical staff living with diabetes. It’s about the wider advances in medical technology and the doors these innovations are opening for our industry. By embracing such developments, we can support colleagues in managing a range of health conditions, enabling them to continue fulfilling their safety-critical roles effectively.