Would you fly with a pilot on insulin?

Simons, Ries; Koopman, Henk; Osinga, Marja

doi:10.1016/s2213-8587(13)70197-9

Cited by 11 publications

(10 citation statements)

References 7 publications

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“…The importance of providing a good start with clear, positive messages, support, and advice, cannot be overemphasized. It is important to maintain a framework which reassures the child and family that the child is normal and can live a healthy life (although a few restrictions remain regarding safety‐sensitive careers) . Education and proactive discussion around common problems that can occur, such as insulin omission, may help decrease the risk of such problems arising later.…”

Section: Processes Of Carementioning

confidence: 99%

“…Adherence to recommended guidelines for albumin excretion screening leads to earlier detection of abnormal albumin excretion. In addition to intensifying treatment regimen to improve glycemic control, angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy has been shown to reverse this abnormality, with anticipated decrease in risk of nephropathy . Likewise, recognition of early background retinopathy offers the opportunity to intensify and improve glycemic control, which would be expected to decrease the rate of progression to proliferative retinopathy .…”

Section: Quality Of Care Structure Of Care Processes Of Care and Oumentioning

confidence: 99%

“…It is important to maintain a framework which reassures the child and family that the child is normal and can live a healthy life (although a few restrictions remain regarding safety-sensitive careers). 36 Education and proactive discussion around common problems that can occur, such as insulin omission, may help decrease the risk of such problems arising later. In the first weeks, it is important to explain to the family that the honeymoon phenomenon may occur; otherwise they may get confused and experience doubt when insulin needs drop.…”

Section: Structure Of Carementioning

confidence: 99%

“…In addition to intensifying treatment regimen to improve glycemic control, angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy has been shown to reverse this abnormality, with anticipated decrease in risk of nephropathy. 35,36,102,103 Likewise, recognition of early background retinopathy offers the opportunity to intensify and improve glycemic control, which would be expected to decrease the rate of progression to proliferative retinopathy. 103 Regular ophthalmological screening may also identify those requiring urgent ophthalmologic treatment to prevent vision loss.…”

Section: Quality Of Care Structure Of Care Processes Of Care and mentioning

confidence: 99%

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ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes

et al. 2018

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Section: Processes Of Carementioning

confidence: 99%

Section: Quality Of Care Structure Of Care Processes Of Care and Oumentioning

confidence: 99%

Section: Structure Of Carementioning

confidence: 99%

Section: Quality Of Care Structure Of Care Processes Of Care and mentioning

confidence: 99%

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ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes

et al. 2018

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“…This question was raised in a Lancet commentary published on‐line . Reviewing the available evidence and the safety processes put in place, the authors conclude that they ‘will confidently fly with an insulin‐treated pilot who has stable glycaemic control, has no substantial disease complications, and is compliant with self‐measurement of pre‐flight and in‐flight blood glucose.’ Not all have been persuaded by the initiative, but, overall, present consensus does recognise that it is the correct direction to take, subject to meticulous monitoring of progress and to rigorous evaluation.…”

Section: Airmentioning

confidence: 99%

Setting occupational standards for insulin‐treated diabetes at sea, on land and in the air

Shaw

2015

Practical Diabetes

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Diabetes, particularly treatment with insulin, has proved a longstanding and frustrating barrier to employment in certain occupations where public safety has been deemed to be potentially at risk. Historically, health and safety issues within the work environment have dictated employment policy, precluding people with diabetes who would otherwise be entirely capable of undertaking required responsible and skilled activities. Such considerations have been especially evident for professional occupations involving both commercial and public transport on land, by sea and in the air. This situation is changing. With the combination of individualised diabetes management and implementation of the Disability Discrimination Act, it is no longer appropriate to apply a 'blanket ban' restriction to employment irrespective of circumstances.The UK Maritime and Coastguard Agency (MCA), the Driving and Vehicle Licensing Agency (DVLA) and the Civil Aviation Authority (CAA) have each accepted the principle that insulin-treated diabetes should no longer be an absolute contraindication to occupational employment, but to be potentially permissable subject to strict, robust individual assessment. Each transport agency has established regulatory standards and operational protocols appropriate for their respective domains with a prime emphasis on minimising hypoglycaemia risk. Ensuring public safety remains paramount, but, with these protocol surveillance and assessment processes in place, it has proved possible for individuals with insulin-treated diabetes to achieve fitness certification and gain employment previously excluded to them. Over the last few years, despite having diabetes and being treated with insulin, many merchant seafarers, drivers of heavy goods vehicles and commercial airline pilots have successfully achieved fitness accreditation to work safely and reliably within these special occupational situations. IntroductionAs any person with diabetes will be well aware, the issue of employment and perceived occupational risk has been a longstanding controversy but one that now engages a more liberal attitude. Not that long ago, treatment with insulin would be regarded by many employers as potentially compromising to safety and effectiveness at work. Many people with diabetes found that they were prevented from obtaining gainful employment for which they were otherwise entirely suited. Reversing this situation has been a long and challenging process, involving determination and a championing of the way forward. As modern treatment and management of diabetes have advanced in so many ways with a crucial emphasis on personalised care, so it has become inappropriate to simply apply a 'blanket ban' irrespective of individual circumstances and capabilities. The Disability Discrimination Act of 1995, and more recent amendments, finally legislated that it was no longer lawful to discriminate against a person because of their condition, and this applies to insulin-treated diabetes. However, the Disability Discrimination Act d...

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