Diabetes Mellitus & Aeromedical Considerations – Χρύσα Ι. Στάθη

Diabetes Mellitus & Aeromedical Considerations

DIABETES AMEDiabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.

Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.

Type 1 diabetes (previously known as insulindependent, juvenile or childhood onset) is characterized by deficient insulin production and requires daily administration of insulin. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly.

Type 2 diabetes (formerly called non insulin-dependent or adult onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity. Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.

 

Diabetes: Key facts

  • 347 million people worldwide have diabetes
  • In 2004, an estimated 3.4 million people died from consequences of high fasting blood sugar.
  • More than 80% of diabetes deaths occur in low and middle income countries.
  • WHO projects that diabetes will be the 7th leading cause of death in 2030.
  • Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of type 2 diabetes.
  • The number of people with diabetes in the European Region 60 million

Diabetes mellitus diagnostic criteria

Intrinsic risks of aeromedical relevance

  • Untreated or poorly controlled DM
  • Coronary artery disease
  • Hypertension
  • Diabetic complications
  • Retinopathy
  • Peripheral neuropathy
  • Nephropathy

Extrinsic risks of aeromedical relevance

  • Hypoglycemia
  • Iatrogenic
  • Sudden or insidious incapacitation
  • Up to 36% of individuals who experienced severe hypoglycemia do not have any warning symptoms
  • Performance degradation with task complexity
  • Reaction times do not return to baseline 20
  • 30 minutes after restoration of euglycemia

Principles of management

  • Optimise blood glucose control but avoid aggressive glucose lowering
  • Reduce incidence of micro and macrovascular complications
  • Pharmacological treatment does not substitute lifestyle modification measures
  • Motivation and compliance are enablers to optimal diabetes control and retention in aviation duties

Targets of satisfactory control for aviation duties

  • BMI 25 kg/m
  • Blood pressure 140/90 mmHg
  • HbA1c 7%
  • Fasting blood glucose 6.7 mmol/L
  • Fasting lipid profile within target treatment range for high cardiovascular risk group

     

Diabetes mellitus treatment Compatible with aviation duties

  • Lifestyle modification measures
  • MetforminThiazolidinediones*
  • DPP4 inhibitors*
  • Alpha-glucosidase inhibitors
  • GLP 1 Analogues
  • SGLT2 Inhibitors*

*To be reviewed if used in combination with another class of oral hypoglycemic agent due to potentiating effects for hypoglycemia

  • Incompatible / used with caution in aircrew

     

  • Sulphonylureas
  • Meglitinides
  • Insulin

     

    Applicants with insulin treated diabetes mellitus shall be assessed as unfit

     

     

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