ADA Advocacy for Pilots with Diabetes

For decades, the American Diabetes Association® (ADA) has advocated for pilots with diabetes. With the remarkable advances in diabetes science, medicine, and treatment, the ADA’s goal has been to secure appropriate FAA regulatory changes that make it possible for qualified, insulin-treated pilots who have well-controlled diabetes to become professional pilots. The ADA has advocated by educating, negotiating with, and ultimately by supporting litigation all geared toward convincing the FAA that it is medically appropriate to conduct individualized assessments for pilots treated with insulin who seek a private or commercial pilot’s license. The ADA has met with the FAA, brought industry stakeholders to the table, convened a panel of expert endocrinologists to provide recommendations, engaged members of Congress, and filed friend-of-the-court briefs in litigation brought by pilots to challenge FAA inaction. 

The ADA’s efforts were ultimately successful. The changes to FAA policy, first for private pilots and then for commercial, would not be possible without the dedication of tireless ADA health care professional volunteers, ADA attorney volunteers, and the brave pilots with diabetes who fought for fairness and change. 

Read our press release on the FAA announcing protocols for pilots with insulin-treated diabetes to pilot commercially. 

FAQ on FAA Medical Certificate Protocol

What protocol must I follow to pilot commercially?
A first or second class medical certificate is required to pilot commercially. 

What are the steps to get a first or second-class medical certificate?
To get a first or second-class medical certification, you must use a CGM. In addition, there are different categories of data and medical records that must be submitted with the application. These include:

1. Initial comprehensive clinical consolation from your treating board-certified endocrinologist.
2. Initial/annual comprehensive lab panel
3. Monthly CGM data with a device that meets FAA requirements for the preceding 12 months (when available) in overlay view. It should show trends per day of actual readings, not only averages. 
     —minimum of 6 months of readings if recently started on a CGM
4. Eye evaluation from a board-certified ophthalmologist
5. Cardiac Risk Evaluation

More details on the procedures for a pilot with insulin-dependent diabetes seeking first or second-class medical certification can be found here.

More information, including information on renewals and an FAQ on the process, can also be found here. 

What process should I follow if I have diabetes but do not use insulin?
Applicants with diabetes controlled by a medication other than insulin have to submit a few different materials in order to be considered for an Authorization for Special Medical Certificate. These are:

1. Diabetes or Hyperglycemia on Oral Medications Status Report; OR
2. A current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or endocrinology no more than 90 days prior to the AME exam. The note should include:
   —A detailed summary of the history of the condition;
   —Treatments and outcomes;
   —Current medications, dosage, and side effects (if any);
   —Physical exam findings;
   —Results of any testing performed;
   —Diagnosis;Assessment;
   —Plan (prognosis); and
   —Follow-up.
3. Clinic progress note should also include any evidence of progressive diabetes-included end organ diseases and if there are any hypoglycemia episodes in the past (one) year.
4. Current Hemoglobin AIC lab test performed no more than 90 days prior to the AME exam (and 30 days after medication change).

After the Authorization is approved, follow up examination is required annually. More information on the process can be found on the FAA’s website. 

More Resources for Pilots

First and Second-Class Medical Certificate Protocol
Collection of guidance documents listing the medical records and data pilots must submit to apply for a first or second-class certificate.

Third-Class Medical Certificate Protocol
Collection of guidance documents listing the medical records and data pilots must submit to apply for a third-class certificate.

Required In-Flight Monitoring for Third-Class Operations
Pilots who use insulin without a CGM are required to follow strict monitoring protocols before and during flight for third-class operations.

Ongoing Medical Certification Requirements
Pilots with a third-class medical certificate with special issuance for insulin use without a CGM must continue to provide specific medical documentation to the FAA to remain eligible to keep his or her license.

All Classes Protocol for Diabetes Treated without Insulin
Pilots who have diabetes and use a medication other than insulin must receive an initial authorization and annual subsequent exams to be considered for a medical certificate for any class.

Medical Certificate Regulations
The Code of Federal Regulations defines the activities which can be performed with each class of medical certificate.