New Insulin-Treated Diabetes Mellitus Policy For Pilots By Michael Berry, M.d., Federal Air Surgeon
As my office works to implement significant changes to our insulin-treated diabetes mellitus (ITDM) protocol, let me take this opportunity to provide an overview. The advent of new technology like continuous glucose monitoring (CGM) played a role in the FAA’s new policy.
Not long after the Wright Brothers first flew, the need for airman physical standards became apparent. Early U.S. Army pilot candidates included those medically disqualified for infantry or cavalry. This was unsuccessful as shown by the British during the first year of WWI: two-percent of aviation losses were due to enemy action, eightpercent to mechanical issues, and ninety-percent medical issues. Sixty-percent of the losses had physical deficits. Once medical standards were in place, the accidents secondary to medical causes dropped to twenty-percent after one year and twelve-percent the following year. Early civilian aeromedical standards closely mirrored those of the U.S. Army. Just as today,
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the medical standards for commercial pilots were more rigorous than for a private pilot, which balances public safety and an individual’s freedom to fly. Through today’s Special Issuance Medical Certificate process, provisions for appropriate evaluation and risk mitigation allow us to routinely evaluate and issue for conditions that were once cause for automatic disqualification. This change is a testament to ongoing improvements in treatment and diagnostic tools. Thanks to specific improvements in the management of ITDM and through consultation with prominent clinical specialists in diabetes, we have determined that some applicants with ITDM can now be favorably considered for either
