Pilots flying with insulin‐treated diabetes

Abstract

People with diabetes treated with insulin have often faced blanket bans from safetycritical occupations, largely because of fear of incapacitation due to hypoglycaemia.Recent advances in insulin therapies, modes of administration, monitoring, and noninvasive monitoring techniques have allowed stereotypical views to be challenged. The aviation sector has led the way, in allowing pilots to fly while on insulin. Recently, countries that have traditionally been opposed to this have changed their minds, largely due to the increasing evidence of safety. The purpose of this review was to gather all available information to update clinicans. The physiology and pathophysiology underpinning glucose regulation and the management of diabetes in the air allowing certain insulin-treated pilots to fly are discussed.

The role of real‐time continuous glucose monitoring in diabetes management and how it should link to integrated personalized diabetes management

“…Therefore, rtCGM has the potential to reduce the acute and long‐term risks of developing diabetes‐related complications, requiring ambulance call‐outs, hospital admissions and the negative impact on cognition. rtCGM has paved the way to enable people with insulin‐treated diabetes to pursue or retain their chosen career and employment paths, for example, within aviation, which were previously restricted in some countries 75 …”

“…rtCGM has paved the way to enable people with insulin-treated diabetes to pursue or retain their chosen career and employment paths, for example, within aviation, which were previously restricted in some countries. 75 Despite the outlined benefits of rtCGM, there are several challenges that prevent the widespread implementation and adoption of integrating rtCGM systems in diabetes management. The cost of rtCGM and rtCGM-linked technologies remains significant and therefore becomes a barrier to access for those who do not get coverage by insurance or meet the required criteria for access and reimbursement via their national health system.…”

The Prevalence of Cardiometabolic Health Risk Factors among Airline Pilots: A Systematic Review

“…Investigation of impaired glucose tolerance and hyperglycemia is scarce in the airline pilot literature, with only two studies reporting the prevalence of hyperglycemia (30.4-31.3%) [21,27] and scant research reporting on the prevalence of elevated HbA1c, which is the leading diagnostic criteria for T2D [69]. This dearth of information may be attributable to past barriers for diabetic pilots to operate commercials flights due to the risk of incapacitation from hypoglycemia while flying, yet recent advances in insulin therapies, monitoring techniques, and modes of administration have given rise to policy developments reducing barriers for diabetic pilots to operate commercial flights [70]. Seemingly, there is a need for more research attention on glycemic control and identifying the prevalence of elevated risk markers for T2D among airline pilots.…”