Non-invasive glucose monitoring systems along with modern insulin analogues and insulin delivery systems have made flying possible again for insulin-treated pilots, a new review has concluded.

According to a review article by doctors working for the UK’s Civil Aviation Authority,  regulatory authorities in many countries have accepted that the risks from diabetes in pilots are acceptable and possibly continuing to decrease.

It said an interesting observation from one European study of insulin-treated pilots was that out-of-range glucose readings decreased from 5.7% in 2013 to 1.2% in 2019.

“This may be attributable to the widespread introduction of noninvasive CGM systems which most pilots use in parallel to the finger‐prick glucose monitoring protocol. No safety concerns have emerged using this established protocol, which has allowed pilots with insulin‐treated diabetes to safely undertake complex safety‐critical occupational duties.”

The authors also said the potential effects of aviation and altitude on diabetes have been shown to be small and modifiable.

“Thus, overall glucose metabolism may alter subtly with acute changes in pressure; the effects are small and are likely to be outweighed by changes in eating patterns and lack of exercise during flights.”

“Additional problems due to acute decompression are important for people on insulin pumps and corrective action should be taken and clear instructions given as part of any flying protocol,” they wrote in Diabetes, Obesity and Metabolism.

The review cited flying protocols from several countries including Israel, Canada, the UK, New Zealand and the US.

All require full clinical assessments, in-flight glucose monitoring and complication surveillance although details such as mode of glucose monitoring and frequency of in-flight testing vary.

It said the high‐value, closely controlled, and regulated environment of aviation has facilitated data collection in controlled situations.

“The large volumes of detailed data produced by pilots provide a protocol and basis for the safe functioning of individuals treated with hypoglycaemic agents. These protocols and data now allow the empowerment of individuals with diabetes and the return of a valuable sector of society to some productive activities.”

Watch Australian Dr Jeremy Robertson, medical doctor and commercial pilot, talk about getting his wings back last year after a diagnosis of type 1 diabetes.