title: The U.S. Experience with Waivers for Insulin-Treated Pilots.
abstract: BACKGROUND
  This study explores the U.S. experience with waivers for insulin treatment for third-class medical certificates. From 1997 through 2014, the Federal Aviation Administration (FAA) approved an estimated 1500 waivers for insulin-treated diabetes with a total of 450 active waivers as of December 31, 2014. These pilots were involved in 25 accidents, but none were attributed to medical issues.
  
  
  METHODS
  Data for the insulin waiver group and control group were obtained from the FAA's aeromedical certification system and matching accident data from the NTSB database. A logistic regression model comparing accidents in this group to the overall population of third-class certificate holders adjusted for gender, age, and flight times was performed. A novel technique for calculating accident rates was also employed.
  
  
  RESULTS
  No statistically significant association between waivers for insulin treatment and accident risk was found by logistic regression. The overall accident rate for pilots possessing an insulin waiver was 7.0 per 100,000 flight hours and an estimate for all third-class pilots was also 7.0 per 100,000 flight hours. Only 8% of waivers for insulin treatment were later terminated for adverse changes related to the applicant's diabetes. Of these pilots, 8% also had coronary artery disease severe enough to require its own waiver.
  
  
  CONCLUSIONS
  Taken together, these findings suggest that pilots holding special issuance waivers for insulin-treated diabetes are not detectably less safe than other airmen with third-class medical certificates and most are able to successfully comply with the FAA's stringent medical certification protocol for insulin treated diabetes.Mills WD, DeJohn CA, Alaziz M. The U.S. experience with waivers for insulin-treated pilots. Aerosp Med Hum Perform. 2017; 88(1):34-41.
authors.forename: William D
authors.initials: WD
authors.lastname: Mills
authors.forename: Charles A
authors.initials: CA
authors.lastname: DeJohn
authors.forename: Mustafa
authors.initials: M
authors.lastname: Alaziz
mesh_terms: D000060:Accidents, Aviation / Q000706:statistics & numerical data*; D000328:Adult; D000337:Aerospace Medicine; D015190:Blood Glucose Self-Monitoring / Q000592:standards; D016022:Case-Control Studies; D002568:Certification; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D005080:Exercise Test; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000070356:Pilots; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin