Pre- and in-flight blood glucose monitoring data, collected since 2012, have been evaluated. This study collated data from 49 pilots from the U.K., Ireland, and Austria who have been using the protocol since its introduction in 2012. 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). pilots who received a certificate from 2012 through March 2015 were published in 2017 ( 8). The protocol demands rigorous oversight, documentation, and systematic collection of data. in progressing this initiative, and the protocol was approved by the European Aviation Safety Agency. Ireland (2015) and Austria (2016) joined with the U.K. CAA created such a protocol and started to issue class 1 medical certificates to insulin-treated pilots ( 7). This required the development and evaluation of a medical assessment protocol through which a defined number of medical certificates may be issued to pilots, with appropriate limitations. However, a mechanism exists within the regulations whereby the identification of new medical technologies, medications, or procedures may justify the assessment of whether applicants are fit to fly. Current European Union regulations do not permit the issuance of class 1 medical certificates (required to validate a commercial pilot’s license) or class 2 medical certificates (required to validate a private pilot’s license) to people with insulin-treated diabetes. At that time, glucose monitoring through blood samples obtained by finger stick was stipulated as a requirement for the protocol. Civil Aviation Authority (CAA) convened an expert committee to review scientific knowledge and subsequently developed a protocol to ensure safe flying by insulin-treated pilots. Canada became the first country to permit carefully selected pilots with insulin-treated diabetes to fly commercial aircraft in 2002 ( 6). Although several countries grant aeromedical certification for leisure purposes to individual pilots with insulin-treated diabetes on a case-by-case basis ( 1, 4, 6), others have campaigned to be licensed to fly commercial aircraft ( 1).
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