Continuous blood glucose monitoring safe for pilots with diabetes

- EN - DE
 (Image: Pixabay CC0)
(Image: Pixabay CC0)
In recent years, permanent glucose measurement from tissue fluid has become established, especially for type 1 diabetics who are constantly dependent on insulin to control their blood glucose. According to the latest study by an Austrian-British-Irish research team, such a system is also safe for professional pilots.

Experts led by David Russel-Jones, an endocrinologist at the University of Surrey, with co-authors from Ireland and Austria (from Austrocontrol and the Clinical Department of Endocrinology and Diabetology at Med Uni Graz) have addressed a particularly important issue for some commercial pilots: controlling blood glucose levels in the event of diabetes. "Currently, only three countries in Europe - Great Britain, Austria and Ireland - give pilots with diabetes a full professional license in commercial aviation," the British university wrote in a press release last spring.

Care for diabetics greatly improved

The restrictions are understandable in that diabetics can slip into an episode of hypoglycemia (low blood sugar) by taking too much insulin compared to their intake of carbohydrates. This can result in confusion or even fainting. So it comes down to precise blood glucose control. Here, however, the situation has changed considerably due to the constant improvements in devices for self-measurement of blood glucose. Julia Mader, a diabetologist from Graz, was quoted by the University of Surrey as saying: "The care of diabetics has improved greatly over the past 20 years. Patients can easily measure and control their insulin levels (and thus blood glucose concentration). "Whereas in the past blood glucose self-measurement was based exclusively on multiple daily pricks into a fingertip and subsequent measurement via test strips and small portable devices, more recently glucose measurement from tissue fluid has revolutionized the situation. A small sensor is glued to the skin, often on the upper arm. The sensor, which extends under the skin, measures tissue glucose levels continuously for ten days, for example, correlating with blood glucose. The values are sent to a compatible cell phone and displayed in real time. If glucose levels are problematic, the system sounds an alarm. This eliminates the need to draw blood several times a day, which is simply unpleasant and also painful.

The current study, now published in Diabetes Technology & Therapeutics, included a total of eight professional pilots. Their mean age was 48.5 years, seven of them had type 1 diabetes (insulin-dependent diabetes), one had type 3c diabetes with insufficient insulin production by the pancreas due to another disease of the organ.The pilots, who had already suffered from diabetes for a mean of 11.5 years, were asked to continue to routinely determine their blood glucose levels from fingertip blood. At the same time, they received a continuous glucose monitoring system with a sensor system (Dexcom G6). Finally, 874 values from both measurement methods, used before and during professional piloting of airplanes, were compared.

Conclusion: The blood glucose values were de facto consistent. There were no statistically relevant deviations. "Continuous glucose monitoring (...) is a safe alternative to blood glucose self-monitoring for pilots in commercial aviation," concluded the authors, who included Julia Mader from the Clinical Department of Endocrinology and Diabetology at Med Uni Graz.

Great advantages through permanent measurement systems

Especially for patients with intensified insulin therapy, the modern permanent measurement systems offer great advantages: The values are recorded day and night. Diabetics, for example, can easily slip into hypoglycemia at night, which they often do not notice during sleep. Tissue glucose measurement via sensors indicates trends and can sound the alarm. With a more precisely adjusted insulin therapy, the medium-term blood glucose value (HbA1c) can also be improved. In addition, wearing the sensors is often perceived as significantly more comfortable than blood glucose self-measurement systems with needles. On the occasion of another study of diabetes in flight conditions, David Russel-Jones of the University of Surrey said, "If diabetes is well controlled, it shouldn’t prevent anyone from taking on important roles, such as piloting aircraft in commercial aviation." But he added that this would also require accurate research into the influence of the particular conditions on diabetes.

Text reference: from 09.08.2023