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Guide for Aviation Medical Examiners

Decision Considerations
Disease Protocols - Diabetes Mellitus Type II - Medication Controlled

This protocol is used for all diabetic applicants treated with oral agents or incretin mimetic medications (such as exenatide), herein referred to as medication(s).

An applicant with a diagnosis of diabetes mellitus controlled by medication may be considered by the FAA for an Authorization of a Special Issuance of a Medical Certificate (Authorization). For medications currently allowed, see chart of Acceptable Combinations of Diabetes Medications (PDF).

When medication is started the following time periods must elapse prior to certification to assure stabilization, adequate control, and the absence of side effects or complications from the medication.

  • Metformin only. A 14 day period must elapse.
  • Any other single diabetes medication requires a 60-day period.

The initial Authorization decision is made by the AMCD and may not be made by the Examiner. An Examiner may re-issue a subsequent airman medical certificate under the provisions of the Authorization.

The initial Authorization determination will be made on the basis of a Diabetes or Hyperglycemia on Oral Medications Status Report (PDF) signed and completed by the airman's treating provider or a report from the treating physician. The report must contain a statement regarding the medication used, dosage, the absence or presence of side effects and clinically significant hypoglycemic episodes, and an indication of satisfactory control of the diabetes. The results of an A1C hemoglobin determination within the past 30 days must be included. Note must also be made of the presence of cardiovascular, neurological, renal, and/or ophthalmological disease. The presence of one or more of these associated diseases will not be, per se, disqualifying, but the disease(s) must be carefully evaluated to determine any added risk to aviation safety.

Re-issuance of a medical certificate under the provisions of an Authorization will also be made on the basis of reports from the treating physician. The contents of the report must contain the same information required for initial issuance and specifically reference the presence or absence of satisfactory control, any change in the dosage or type of medication, and the presence or absence of complications or side effects from the medication. In the event of an adverse change in the applicant's diabetic status (poor control or complications or side effects from the medication), or the appearance of an associated systemic disease, an Examiner must defer the case with all documentation to the AMCD for consideration.

If, upon further review of the deferred case, AMCD decides that re-issuance is appropriate, the Examiner may again be given the authority to re-issue the medical certificate under the provisions of the Authorization based on data provided by the treating physician, including such information as may be required to assess the status of associated medical condition(s).

At a minimum, followup evaluation by the treating physician of the applicant's diabetes status is required annually for all classes of medical certificates.

An applicant with diabetes mellitus - Type II should be counseled by his or her Examiner regarding the significance of the disease and its possible complications.

The applicant should be informed of the potential for hypoglycemic reactions and cautioned to remain under close medical surveillance by his or her treating physician.

The applicant should also be advised that should their medication be changed or the dosage modified, the applicant should not perform airman duties until the applicant and treating physician has concluded that the condition is:

  • under control;
  • stable;
  • presents no risk to aviation safety; and
  • consults with the Examiner who issued the certificate, AMCD or RFS.

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