{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T15:20:58Z","timestamp":1769354458808,"version":"3.49.0"},"reference-count":19,"publisher":"American Diabetes Association","issue":"12","license":[{"start":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T00:00:00Z","timestamp":1605830400000},"content-version":"vor","delay-in-days":148,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>The risk of hypoglycemia in people with insulin-treated diabetes has debarred them from certain \u201csafety-critical\u201d occupations, including flying commercial aircraft. This report evaluates the effectiveness of a protocol enabling a large cohort of insulin-treated pilots to fly commercially.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>This 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\u201315 mmol\/L), amber (low, 4\u20134.9 mmol\/L; high, 15.1\u201320 mmol\/L), and red (low, &amp;lt;4 mmol\/L; high, &amp;gt;20 mmol\/L).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>A 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 HbA1c was 7.2% (55.0 mmol\/mol) before certification and 7.2% (55.1 mmol\/mol) after certification (P = 0.97). Blood glucose values (n = 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The 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 \u201csafety-critical\u201d occupation, which may be relevant when estimating risk in other safety-critical occupations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc20-0277","type":"journal-article","created":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T20:19:33Z","timestamp":1593116373000},"page":"2923-2929","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":15,"title":["An Evaluation of the Safety of Pilots With Insulin-Treated Diabetes in Europe Flying Commercial and Noncommercial Aircraft"],"prefix":"10.2337","volume":"43","clinical-trial-number":[{"clinical-trial-number":"nct04225455","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Gillian L.","family":"Garden","sequence":"first","affiliation":[{"name":"University of Surrey, Guildford, U.K."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia L.","family":"Hine","sequence":"additional","affiliation":[{"name":"University of Surrey, Guildford, U.K."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart J.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Civil Aviation Authority, Crawley, West Sussex, U.K."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ewan J.","family":"Hutchison","sequence":"additional","affiliation":[{"name":"Civil Aviation Authority, Crawley, West Sussex, U.K."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas P.","family":"Gaffney","sequence":"additional","affiliation":[{"name":"Irish Aviation Authority, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronika","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Austro Control, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian M.","family":"Frier","sequence":"additional","affiliation":[{"name":"The Queen\u2019s Medical Research Institute, University of Edinburgh, Edinburgh, U.K."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth M.","family":"Shaw","sequence":"additional","affiliation":[{"name":"University of Portsmouth, Portsmouth, U.K."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2425-9565","authenticated-orcid":false,"given":"Simon R.","family":"Heller","sequence":"additional","affiliation":[{"name":"Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, U.K."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerd","family":"Koehler","sequence":"additional","affiliation":[{"name":"Austro Control, Vienna, Austria"},{"name":"Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graham A.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Irish Aviation Authority, Dublin, Ireland"},{"name":"CRF-C University College Cork, HRB Clinical Research Facility Cork, Mercy University Hospital, Cork, Ireland"},{"name":"Diabetes Research Group, Swansea University, Swansea, U.K."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9490-2480","authenticated-orcid":false,"given":"David L.","family":"Russell-Jones","sequence":"additional","affiliation":[{"name":"University of Surrey, Guildford, U.K."},{"name":"Civil Aviation Authority, Crawley, West Sussex, U.K."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1167","published-online":{"date-parts":[[2020,6,25]]},"reference":[{"key":"2022031220363008100_B1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.diabres.2012.05.021","article-title":"Fighting discrimination","volume":"98","author":"Wientjens","year":"2012","journal-title":"Diabetes Res Clin Pract"},{"key":"2022031220363008100_B2","volume-title":"Fitness for Work: the Medical Aspects","author":"Palmer","year":"2007","edition":"4th ed"},{"key":"2022031220363008100_B3","first-page":"446","article-title":"Would you fly with a pilot on insulin","volume-title":"Lancet Diabetes Endocrinol","author":"Simons","year":"2014"},{"key":"2022031220363008100_B4","doi-asserted-by":"crossref","first-page":"34","DOI":"10.3357\/AMHP.4726.2017","article-title":"The U.S. experience with waivers for insulin-treated pilots","volume":"88","author":"Mills","year":"2017","journal-title":"Aerosp Med Hum Perform"},{"key":"2022031220363008100_B5","first-page":"34","article-title":"Discrimination on high: flying on insulin","volume":"48","author":"Steele","year":"2003","journal-title":"Diabetes Soc"},{"key":"2022031220363008100_B6","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1089\/dia.2018.0099","article-title":"Real-time continuous glucose monitoring usage in pilots with diabetes: an option to improve safety","volume":"20","author":"Jendle","year":"2018","journal-title":"Diabetes Technol Ther"},{"key":"2022031220363008100_B7","unstructured":"UK Civial Aviation Authority, Medical Department\n          . UK CAA policy for the medical certification of pilots and ATCOs with diabetes, 2018. Available from https:\/\/www.caa.co.uk\/uploadedFiles\/CAA\/Content\/Standard_Content\/Medical\/Metabolic_and_Endocrinology\/Files\/v5.0%20Nov%202018%20Diabetes%20Guidance%20Material.pdf. Accessed 12 September 2019"},{"key":"2022031220363008100_B8","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/S2213-8587(17)30264-4","article-title":"A UK Civil Aviation Authority protocol to allow pilots with insulin-treated diabetes to fly commercial aircraft","volume":"5","author":"Mitchell","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2022031220363008100_B9","doi-asserted-by":"crossref","unstructured":"Manen\u2008O, Martel\u2008V, Germa\u2008R, et al. Should a pilot on insulin really fly? Lancet Diabetes Endocrinol\u20082014;2:451","DOI":"10.1016\/S2213-8587(14)70056-7"},{"key":"2022031220363008100_B10","doi-asserted-by":"crossref","first-page":"2335","DOI":"10.2337\/diacare.27.10.2335","article-title":"Acute hyperglycemia alters mood state and impairs cognitive performance in people with type 2 diabetes","volume":"27","author":"Sommerfield","year":"2004","journal-title":"Diabetes Care"},{"key":"2022031220363008100_B11","doi-asserted-by":"crossref","first-page":"71","DOI":"10.2337\/diacare.28.1.71","article-title":"Relationships between hyperglycemia and cognitive performance among adults with type 1 and type 2 diabetes","volume":"28","author":"Cox","year":"2005","journal-title":"Diabetes Care"},{"key":"2022031220363008100_B12","doi-asserted-by":"crossref","first-page":"180","DOI":"10.2337\/diacare.6.2.180","article-title":"A survey of cognitive functioning at difference glucose levels in diabetic persons","volume":"6","author":"Holmes","year":"1983","journal-title":"Diabetes Care"},{"key":"2022031220363008100_B13","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1177\/1474651412466273","article-title":"The effects of acute hypoglycaemia on cognitive function in type 1 diabetes","volume":"12","author":"Inkster","year":"2012","journal-title":"Br J Diabetes Vasc Dis"},{"key":"2022031220363008100_B14","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2337\/dc16-2215","article-title":"Glucose concentrations of less than 3.0 mmol\/L (54 mg\/dL) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes","volume":"40","author":"International Hypoglycaemia Study Group","year":"2017","journal-title":"Diabetes Care"},{"key":"2022031220363008100_B15","first-page":"861","article-title":"Diabetes mellitus type 1 in five military aviators: flying with insulin","volume":"76","author":"Carter","year":"2005","journal-title":"Aviat Space Environ Med"},{"key":"2022031220363008100_B16","first-page":"449","article-title":"Diabetes mellitus in aircrew--type I diabetes in a pilot","volume":"66","author":"Gray","year":"1995","journal-title":"Aviat Space Environ Med"},{"key":"2022031220363008100_B17","doi-asserted-by":"crossref","first-page":"735","DOI":"10.3357\/AMHP.5315.2019","article-title":"Continuous glucose monitoring for in-flight measurement of glucose levels of insulin-treated pilots","volume":"90","author":"Strollo","year":"2019","journal-title":"Aerosp Med Hum Perform"},{"key":"2022031220363008100_B18","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.2337\/dc17-1600","article-title":"International consensus on use of continuous glucose monitoring","volume":"40","author":"Danne","year":"2017","journal-title":"Diabetes Care"},{"key":"2022031220363008100_B19","unstructured":"Federal Aviation Administration\n          . Special-issuance medical certification: diabetes protocol for applicants seeking to exercise airline transport, commercial, or private pilot privileges. Fed Regist\u20082019;84:60137\u201360140"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/43\/12\/2923\/530887\/dc200277.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/43\/12\/2923\/530887\/dc200277.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,12]],"date-time":"2022-03-12T22:41:11Z","timestamp":1647124871000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/43\/12\/2923\/30964\/An-Evaluation-of-the-Safety-of-Pilots-With-Insulin"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,25]]},"references-count":19,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,6,25]]},"published-print":{"date-parts":[[2020,12,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc20-0277","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,25]]}}}