FAA issues first medicals to professional pilots with insulin-treated diabetes

Following several years of literature review, analysis, and consultation with diabetes experts, the FAA has issued medical certificates under special issuance authorization to the first commercial pilots who use insulin to treat diabetes. These new issuances are the result of an exhaustive process of review of data, particularly the technology and accuracy of continuous glucose monitoring (CGM), which has significantly improved diabetic patients’ blood glucose control. CGM was a key factor in the FAA’s decision to publish the policy announcement in late 2019.

“With the use of CGM as a required element of the policy for first and second class medical certification, the FAA’s Office of Aerospace Medicine is now able to establish the required level of safety for the national airspace system, a responsibility and mandate that they take very seriously. They can’t ever put the toothpaste back in the tube,” said Gary Crump, AOPA’s director of medical certification. “They are always going to take whatever time it takes to ‘get it right the first time.’” In this case, it took several years for all that data analysis, literature review, and consultants’ expertise to create a workable policy.

AOPA was a strong proponent in 1996 for the change that led to establishment of a policy allowing special issuance of third class medicals to private pilots with insulin-dependent diabetes. That policy has been quite successful, and the requirements for commercial pilots, though robust and comprehensive, incorporate elements of the third class medical policy, including treadmill stress testing for applicants over age 40, comprehensive eye examination, and periodic reports of A1c hemoglobin, in addition to the new requirement for CGM.

“With the ongoing coronavirus pandemic, it’s nice to see some positive news in aviation right now,” said Jim Coon, AOPA senior vice president of government affairs. “While many private pilots who are insulin dependent have been flying safely since 1996, the future of aviation can remain bright as this new protocol will allow an even greater number of qualified pilots to begin flying commercially.”