Challenges in investigation of diabetes-related aviation fatalities—an analysis of 1491 subsequent aviation fatalities in USA during 2011–2016

Abstract

Diabetes mellitus (DM) could cause pilot incapacitation and result in aviation fatalities. The mechanisms could be directly as a consequence of acute hypoglycemia/subacute diabetic ketoacidosis (DKA) or indirectly as an acute cardiovascular event by contributing to the development of atherosclerosis in coronary or carotid and cerebral arteries. In this study, DM-related fatal flight accidents in the US National Transport Bureau's database between years 2011-2016 were analyzed with special emphasis on postmortem (PM) glucose levels and correlation of toxicological reports with anamnestic information on DM. Additionally, autopsy results on coronary arteries were reviewed. In 43 out of 1491 (~ 3%) fatal accidents pilots had DM. Postmortem glucose or glycated hemoglobin percentage (Hb1Ac) was measured in 12 of the 43 cases; while antidiabetic medication was found in 14 of the cases (only two of the cases had both glucose measurements and medication). With the increasing prevalence of DM, a possibility of pilot incapacitation due to DM or complications of DM should be actively studied, even if no anamnestic information of DM was available. While PM hypoglycemia is difficult to assess, we propose a systematic investigation based on measurement of glucose, Hb1Ac%, and ketone bodies, and documentation of atherosclerotic lesions in major arteries to identify or rule out DM as a cause of pilot incapacitation.

Risk Factors for Cardiovascular Diseases in Aircrew

“…Risk Factors for Cardiovascular Diseases in Aircrew DOI: http://dx.doi.org/10.5772/intechopen.99905 can grievously compromise flight safety and harm not only the aircrew himself but also the passengers, the aircraft, and the environment [15]. The relationship between blood glucose control and the establishment of CVD in diabetes remains a matter of controversy.…”

Previous Military Pilots and Their Later Fatal Civil Aviation Accidents

“…In the control group elevated blood sugar was present in 2% of accident cases. In a recent study regarding diabetes-related aviation fatalities (n = 1491) about 3% of pilots had diabetes mellitus (DM) (Junttila et al, 2018). The rigorous selection of military pilots does not exclude the later risk factors of diabetes.…”