A UK Civil Aviation Authority protocol to allow pilots with insulin-treated diabetes to fly commercial aircraft

Mitchell, Stuart J.; Hine, Julia; Vening, Jill; Montague, Joanne; Evans, Sally; Shaw, Ken; Frier, Brian M.; Heller, Simon; Russell‐Jones, David

doi:10.1016/s2213-8587(17)30264-4

Cited by 17 publications

(16 citation statements)

References 5 publications

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“…A "traffic light" system was devised to govern acceptable pre-and in-flight glucose ranges (8), with green signifying "acceptable" (5.0-15.0 mmol/L [90-270 mg/dL]), amber indicating "caution" (low, 4.0-4.9 mmol/L [72-88 mg/dL]; high, 15.1-20.0 mmol/L [272-360 mg/dL]), and red requiring immediate action (low, ,4.0 mmol/L [,72 mg/dL]; high, .20.0 mmol/L [.360 mg/dL]). Low amber values require the pilot to ingest 10-15 g readily absorbed carbohydrate and remeasure glucose after 30 min.…”

Section: Methodsmentioning

confidence: 99%

“…The protocol demands rigorous oversight, documentation, and systematic collection of data. The results from U.K. pilots who received a certificate from 2012 through March 2015 were published in 2017 (8). However, some commentators have expressed concerns about the practicality of performing in-flight glucose measurements and speculated that the avoidance of low glucose values because of the protocol would lead to suboptimal glycemic control and increase the risk of diabetes complications (3,9).…”

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confidence: 99%

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An Evaluation of the Safety of Pilots With Insulin-Treated Diabetes in Europe Flying Commercial and Noncommercial Aircraft

et al. 2020

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The risk of hypoglycemia in people with insulin-treated diabetes has debarred them from certain "safety-critical" occupations, including flying commercial aircraft. This report evaluates the effectiveness of a protocol enabling a large cohort of insulintreated pilots to fly commercially. RESEARCH DESIGN AND METHODSThis was an observational study of pilots with insulin-treated diabetes who were granted medical certification to fly commercial and noncommercial aircraft. Clinical details, pre-and in-flight (hourly and 30 min before landing) blood glucose values were correlated against the protocol-specified ranges: green (5-15 mmol/L), amber (low, 4-4.9 mmol/L; high, 15.1-20 mmol/L), and red (low, <4 mmol/L; high, >20 mmol/L). RESULTSA total of 49 pilots with type 1 (84%) or type 2 (16%) diabetes who had been issued class 1 or class 2 certificates were studied. Median diabetes duration was 10.9 years. Mean HbA 1c was 7.2% (55.0 mmol/mol) before certification and 7.2% (55.1 mmol/ mol) after certification (P 5 0.97). Blood glucose values (n 5 38,621) were recorded during 22,078 flying hours. Overall, 97.69% of measurements were within the green range, 1.42% within the low amber range, and 0.75% within the high amber range. Only 0.12% of readings were within the low red range and 0.02% within the high red range. Out-of-range readings declined from 5.7% in 2013 to 1.2% in 2019. No episodes of pilot incapacitation occurred, and glycemic control did not deteriorate. CONCLUSIONSThe protocol is practical to implement, and no events compromising safety were reported. This study represents what is, to our knowledge, the most extensive data set from people with insulin-treated diabetes working in a "safety-critical" occupation, which may be relevant when estimating risk in other safety-critical occupations.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

An Evaluation of the Safety of Pilots With Insulin-Treated Diabetes in Europe Flying Commercial and Noncommercial Aircraft

et al. 2020

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“…19 The first peer-reviewed paper reporting data from insulin-treated commercial pilots came from the United Kingdom. 20 This reported 9000 flying hours from 16 Class 1 pilots. There were no reported safety issues and the protocol was found to be feasible and practical.…”

Section: Published Data Of People Treated With Insulin Who Are Allowed To Flymentioning

confidence: 99%

Pilots flying with insulin‐treated diabetes

Russell‐Jones

Hutchison

Roberts

2021

Diabetes Obesity Metabolism

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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.

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“…Acceptable in‐flight blood glucose concentrations and ranges were defined and designated using a ‘traffic‐light’ system of green (acceptable, >5–15mmol/L), amber (caution, 4–5mmol/L and >15–20mmol/L) and red (immediate action, <4mmol/L and >20mmol/L). Following strict fitness criteria, the CAA commenced issuing commercial (Class 1) medical certificates, and by March 2015, 16 (62%) of 26 licensed pilots with insulin treated diabetes had successfully returned to flying duties 10 . During a three‐year period (2012–2015) 8897 pre‐flight and in‐flight blood glucose values were recorded over 4900 hours of flight time.…”

Section: Achievement In Aviation – Airline Pilot Safety Evaluatedmentioning

confidence: 99%

Enabling equality of employment with insulin treated diabetes in safety‐critical occupations

Shaw

Garden

2020

Practical Diabetes

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A UK Civil Aviation Authority protocol to allow pilots with insulin-treated diabetes to fly commercial aircraft

Cited by 17 publications

References 5 publications

An Evaluation of the Safety of Pilots With Insulin-Treated Diabetes in Europe Flying Commercial and Noncommercial Aircraft

An Evaluation of the Safety of Pilots With Insulin-Treated Diabetes in Europe Flying Commercial and Noncommercial Aircraft

Pilots flying with insulin‐treated diabetes

Enabling equality of employment with insulin treated diabetes in safety‐critical occupations

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