Background: In 1959, the Department of Transportation enacted safety regulations that included a blanket ban on insulin use by pilots. In 1996, in response to American Diabetes Association® (ADA) advocacy, the Federal Aviation Administration (FAA) began allowing insulin-treated (ITDM) pilots to fly privately. The success of this program led to approximately 500 pilots certified to fly privately with no adverse events related to diabetes. Nonetheless, the ban on insulin use remained intact for commercial pilots. Some ITDM pilots continued working but chose to avoid insulin and accept the resulting increased hyperglycemia and long term complications.

Interventions: The ADA began a strategy of multi-disciplinary interventions to reverse the blanket ban, including engaging “grassroots” and “grasstops” advocates, litigation, and legislative efforts. In 2014, an expert ADA medical panel reviewed relevant National Transportation and Safety Board data and recommended criteria to identify pilots capable of avoiding hypo and hyperglycemia in flight. When the FAA remained reluctant to overturn its longstanding policy, ADA continued its advocacy to encourage the FAA to adopt its recommendations by providing legal and medical support to ITDM pilots engaged in litigation against the FAA. Increasingly accurate continuous glucose monitoring (CGM) technology contributed to the FAA’s decision to overturn the blanket ban. Indeed, the new protocol requires pilots to use a CGM.

Results: In November 2019 the FAA published a new protocol for insulin-treated commercial pilots which eliminates the blanket ban.

Conclusions: The ADA’s unique structure and position enabled it to take the lead in dramatically improving the lives of pilots with diabetes. This achievement follows the ADA’s accomplishments for commercial drivers with diabetes and demonstrates that the ADA’s interdisciplinary collaboration model is successful in overcoming barriers to employment for people with diabetes.


D. Lorber: None. S. Fech-Baughman: None.

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