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Type 2 Diabetes - Non-insulin dependent - High risk of hypoglycaemia

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Definition

This guidance should be used for applicants treated with any of:

  • Sulphonylureas
  • Glitazones
  • Glinides

Aeromedical Implications

Effect of aviation on condition

  • Difficulty with regular blood-sugar monitoring
  • Irregular meal and sleep times
  • Sedentary occupation
  • Access to emergency sugar

Effect of condition on aviation

  • Overt incapacitation
    • Cardiovascular event
    • Cerebrovascular event
  • Subtle incapacitation - end-organ damage
    • Visual impairment (fields, low contrast sensitivity, colour)
    • Impaired motor and sensory nerve function
    • Impaired autonomic function (hypoglycaemia awareness)

Effect of treatment on aviation

  • Loss of consciousness due to hypoglycaemic event

Approach to medical certification

Most information derived from assessments already undertaken as part of best-practice management guidelines. See Diabetes Australia and RACGP for guidance.

  • Based on the condition
    • Confirmed diagnosis
    • Complications of diabetes (eye, heart, brain, kidney)
    • Hypoglycaemia awareness and absence of autonomic neuropathy
  • Based on Treatment
    • No hypoglycaemic episodes within previous 12 months
    • Absence of significant side effects
  • Demonstrated Stability
    • HbA1c less than 7.5%
    • Record of blood sugar stability without hypoglycaemia

Risk assessment protocol - Information required

New cases

  • Treating doctor report (GP or Endocrinologist) detailing:
    • Current status of diabetes
    • Episodes of symptomatic or biochemical hypoglycaemia / hyperglycaemia in the preceding 12 months and treatment required
    • Assessment of control, HbA1c and glucose monitoring diary
    • Evidence of end-organ damage (kidneys / eyes /erectile dysfunction)
    • Treatment
    • Follow-up recommendation
  • Ophthalmologist or Credentialed Optometrist report detailing:
    • Visual acuity (with and without correction)
    • Retinal disease
    • Pressures (and treatment if required)
    • Any other ophthalmic pathology (fields / contrast sensitivity / colour vision)
  • DAME assessment of the cardiac risk index. (Diabetes, impaired glucose tolerance and impaired fasting glucose all carry 3 points). If more than 14, a Cardiologist report on:
    • any confirmed diagnosis
    • clinical status including any symptoms (chest pain, dyspnoea, palpitations etc)
    • investigations conducted including the results of a recent stress test
    • management:
      • control of risk factors
      • treatment and any side-effects
      • monitoring
      • risk of any acutely disabling cardiovascular event
  • Certification of completion of a diabetic counselling course from a diabetes educator
  • Glucose monitoring diary or printout

Renewal

Class 1 & 3: 12 monthly reports required.

Class 2: 12 monthly reports. Eye report 24-monthly unless end-organ damage evident

  • Treating doctor report (GP or Endocrinologist) detailing:
    • Current status of diabetes
    • Episodes of symptomatic or biochemical hypoglycaemia / hyperglycaemia in the preceding 12 months and treatment required
    • Assessment of control, HbA1c and glucose monitoring diary
    • Evidence of end-organ damage (kidneys / eyes /erectile dysfunction)
    • Treatment
    • Follow-up recommendation
  • A report from an Ophthalmologist or Credentialed Optometrist detailing:
    • Visual acuity (with and without correction)
    • Retinal disease
    • Pressures (and treatment if required)
    • Any other ophthalmic pathology (fields / contrast sensitivity / colour vision)
  • An assessment by the DAME of the cardiac risk index. IF more than 14, a report from a Cardiologist with respect to:
    • any confirmed diagnosis
    • clinical status including any symptoms
    • investigations conducted including the results of a recent stress test
    • management:
      • control of risk factors
      • treatment and any side-effects
      • monitoring
      • risk of any acutely disabling cardiovascular event
  • Glucose monitoring diary or printout

Indicative outcomes

  • On diagnosis, DAME should inform CASA Aviation Medicine Section and advise applicant not to exercise the privileges of their licence until cleared to do so by CASA.
  • Medical certification limited to 12 months duration, on a case by case basis, with restrictions and limitations reflecting the level of control and identified complications.

Favourable:

  • Absence of hypoglycaemic episodes
  • Absence of complications of diabetes
  • Satisfactory control of glucose
  • Complete and consistent personal glucose monitoring
  • Good understanding of personal management of diabetes

Unfavourable:

  • Hypoglycaemia and hypoglycaemic unawareness
  • End-organ damage
  • Poor or unpredictable glucose control
  • Absent or inconsistent personal glucose monitoring.

Pilot and Controller Information

  • Type 2 diabetes is an aeromedically significant medical condition. Pilots and controllers who have been diagnosed with Type 2 Diabetes are required to ground themselves and notify this condition to their DAME.
  • When an applicant’s medication is changed, or when its dosage is changed, they must not exercise the privileges of their medical certificate until cleared by their DAME
  • Monitoring is modelled on Diabetes Australia and the Royal Australian College of General Practitioners recommended practice to minimise additional requirements for aeromedical certification.

Disclaimer

The Clinical Practice Guideline is provided by way of guidance only and subject to the Clinical practice guidelines disclaimer