September 13, 2016
2 min read

UK commercial pilots assigned insulin can fly safely

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The United Kingdom has a strict protocol in place for class 1 medical certificates for commercial pilot licenses issued to those with insulin-treated diabetes, allowing pilots to fly with most blood glucose readings in the safe range, according to findings presented at the 52nd European Association for the Study of Diabetes Annual Meeting.

“A growing number of insulin-treated pilots have successfully applied for [commercial pilots’ licenses] in the [United Kingdom] and, most recently, Ireland,” Julia L. Hine, MD, of Royal Surrey County Hospital in Guildford, United Kingdom, and colleagues wrote. “To date, the [Civil Aviation Authority] protocol has shown to work well in the cockpit, with no reported safety concerns, and without deterioration of diabetes control.”

Hine and colleagues evaluated 26 men (mean age, 40.7 years) with diabetes who were treated with insulin to assess the early experience and safety of the U.K. program that issues class 1 medical certificates for commercial pilot licenses to those treated with insulin.

“The [United Kingdom] now has the largest cohort of insulin-treated pilots, and is leading the way in Europe and beyond to create and maintain employment and leisure opportunities for people with insulin-treated diabetes,” the researchers wrote. “A comprehensive protocol, developed by a panel of medical and aviation experts, governs the medical certification of insulin-treated pilots. Certified pilots are subject to strict requirements, directly overseen by the U.K. Civil Aviation Authority medical department, including pre- and in-flight blood glucose monitoring.”

HbA1c values before and after issuance of a license were compared. Blood glucose monitoring values before and during flight were correlated against the Civil Aviation Authority-specified “green” (5-15 mmol/L), “amber” (4-5 mmol/L and 15-20 mmol/L) and “red” (< 4 mmol/L or > 20 mmol/L) ranges.

Most participants had type 1 diabetes (84.6%) and had an average disease duration of 8.1 years. Follow-up was a mean 19.5 months after the license was issued.

Before the license was issued, mean HbA1c was 53.1 mmol/mol. The most recent mean HbA1c was 54.8 mmol/mol, indicating no significant change before and after licenses were issued.

Overall, 8,897 blood glucose monitoring values were recorded during 4,900 flight hours. Blood glucose levels were within the green range for 95.8% of the 7,829 monitor readings during short and medium haul flights (< 6 hours) and for 96.9% of the 1,068 readings during long haul flights (> 6 hours). There were only 19 readings (0.2%) within the red range.

“Regular blood glucose testing in the cockpit ensures that any variability in blood sugar is detected and can be corrected early,” Hine said in a press release. “If pilots are unable to test their blood sugar due to operational demands, the protocol dictates that they should consume 15 mg of carbohydrate as a precautionary measure and then test within 30 minutes.” – by Amber Cox


Hine JL, et al. OP 71. Presented at: 52nd EASD Annual Meeting; Sept. 12-16, 2016; Munich.

Disclosure: Hine reports no relevant financial disclosures.