{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:48:23Z","timestamp":1740098903206,"version":"3.37.3"},"reference-count":12,"publisher":"Aerospace Medical Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["aerosp med hum perform"],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:p><jats:bold>BACKGROUND:<\/jats:bold> Fighter pilots undergo extensive medical screening but may still miss rare diseases like latent autoimmune diabetes in adults (LADA). LADA patients have circulating autoantibodies directed against pancreatic beta cell antigens and present with frank diabetes late\n in life which may elude conventional military flight screening.<jats:bold>CASE REPORT:<\/jats:bold> Two fifth-generation fighter pilots, a 38-yr-old man (patient 1) and a 27-yr-old man (patient 2), with no significant past medical histories developed symptoms of fatigue, weight loss, episodic polyuria,\n and arthralgia. Patient 1\u2019s symptoms were initially thought to have been caused by COVID-19, but he subsequently tested negative for viral infection. Lab work instead showed elevated TSH, HgbA1C 11.4%, positive GAD-65, anti-TPO, and anti-islet cell antibodies. Patient 2 developed symptoms\n following a military deployment and a 72-h diarrheal illness. Due to flight status, patient 2 did not seek expert medical attention for several months, but lab work found HgbA1C of 10.4%, positive GAD-66, and ZnT8 antibodies. Both patients were started on insulin therapy. Patient 1 was also\n started on levothyroxine for hypothyroidism and retired from flying duties. Patient 2 eventually transitioned to metformin without insulin and returned to flying duties with an aeromedical waiver.<jats:bold>DISCUSSION:<\/jats:bold> Our patients maintained peak physical fitness throughout their selection\n and aviation careers, which likely delayed their clinical presentation. Current USAF flight rules prohibit insulin use with flying fighter aircraft. Early antibody screening during pilot selection may be a cost-effective means of diagnosis as traditional screening techniques are unlikely to\n detect LADA.<jats:bold>Zhang JX, Berry J, Kim NM, Gray JJ, Fotheringham S, Sauerwein TJ. <jats:italic>Two fifth-generation fighter pilots discovered with latent autoimmune diabetes<\/jats:italic>. Aerosp Med Hum Perform. 2022; 93(2):106\u2013110.<\/jats:bold><\/jats:p>","DOI":"10.3357\/amhp.5901.2022","type":"journal-article","created":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T04:41:56Z","timestamp":1643776916000},"page":"106-110","source":"Crossref","is-referenced-by-count":0,"title":["Two Fifth-Generation Fighter Pilots Discovered with Latent Autoimmune Diabetes"],"prefix":"10.3357","volume":"93","author":[{"given":"Joe X.","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Berry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan M.","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin J.","family":"Gray","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savannah","family":"Fotheringham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom J.","family":"Sauerwein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1911","reference":[{"issue":"4","key":"B1","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1210\/jc.2005-1679","article-title":"Type 1 diabetes-associated autoimmunity: natural history, genetic associations, and screening","volume":"91","author":"Barker","year":"2006","journal-title":"J Clin Endocrinol Metab."},{"issue":"1","key":"B2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1210\/jc.2009-1365","article-title":"Clinical applications of diabetes antibody testing","volume":"95","author":"Bingley","year":"2010","journal-title":"J Clin Endocrinol Metab."},{"issue":"10","key":"B3","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.2337\/dbi20-0017","article-title":"Management of latent autoimmune diabetes in adults: a consensus statement from an international expert panel","volume":"69","author":"Buzzetti","year":"2020","journal-title":"Diabetes."},{"key":"B4","first-page":"4","volume-title":"Medical requirements integration documents. 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