Public health

Pilots with diabetes can apply to fly commercial aircraft – thanks to CGM

Pilots with insulin-treated diabetes mellitus (ITDM) now have an avenue for applying for medical certification which will allow them to work as commercial pilots in the US.

According to the American Diabetes Association (ADA), pilots who use insulin have been banned from US commercial operations since 1959.

However the Federal Aviation Administration (FAA) has now taken advice from an ADA expert panel that there is now little risk to flight safety given advances in diabetes management.

“After considering all the evidence and clinical experience, the expert panel concluded that there are pilots with insulin-treated diabetes whose risk of incapacitation in flight is equivalent to, or lower than pilots who do not have insulin-treated diabetes,” the ADA panel said in 2013.

“Their risk, like the risk presented by pilots who do not have insulin-treated diabetes, is nonzero, but extremely improbable. It is the recommendation of the Expert Panel that FAA policy should be updated to reflect current diabetes medicine and permit such pilots medical certification at the first, second, and third class level.”

The use of CGM appears to have been a major factor in tipping the balance in favour of pilots with diabetes.

“CGM monitoring, along with standard clinical follow up, reduces the risk of hypoglycemia, both inflight and outside the flight environment,” the FAA said in a background document to the new protocol.

“CGM usage allows the FAA to identify a low-risk subset and consider applicants whose glycemic stability is sufficiently controlled for safety of flight, even for commercial operations.”

The FAA said applicants should work with their Aviation Medical Examiner and appropriate medical specialists, including endocrinologists, cardiologists and ophthalmologists on the appropriate documentation required for certification.

“For consideration, potential applicants will need to demonstrate stability and adequate control of ITDM using CGM technology for a minimum of at least 6 months.”

However in Australia, insulin-treated diabetes does not meet the Australian Class 1 medical certificate standard for commercial pilots carrying passengers.

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