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

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Definition

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

Diet
Acarbose
Metformin
Gliptens (GPP-4 inhibitors)
Exenatide (GLP-1 agonists)

Aeromedical Implications

Effect of aviation on condition

Irregular meal and sleep times
Sedentary occupation

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

Side-effects including GI and pancreatitis

Approach to medical certification

Most information required for assessments is 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)
- Absence of autonomic neuropathy
Based on Treatment
- Absence of significant side effects
Demonstrated Stability
- HbA1c less than 7.5%

Risk assessment protocol - Information required

New cases

Treating doctor report (GP or Endocrinologist) detailing:
- Current status of diabetes
- Assessment of control, HbA1c
- Evidence of end-organ damage (eyes, heart, kidneys, brain, erectile dysfunction)
- Treatment
A report from an Ophthalmologist or 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
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
- Assessment of control, HbA1c
- Evidence of end-organ damage (eyes, heart, kidneys, brain, erectile dysfunction)
- Treatment
Ophthalmologist or 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

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 complications of diabetes
Satisfactory control of glucose
Good understanding of personal management of diabetes

Unfavourable

End-organ damage
Poor or unpredictable glucose control

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.
Certificate duration limited to 12 months because of the variable nature of the condition and its complications

Disclaimer

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