<abstract xmlns="http://www.w3.org/1999/xhtml"><p>Obesity, the disease of the twenty-first century, has a range of serious consequences to health. These are related in part to abnormal glucose levels, resulting in inflammatory and atherogenic response, hypertension and abnormal lipid profile. This increases the risk of cardiovascular disease significantly besides developing diabetes later. Hyperglycaemia is diagnosed with impaired fasting glucose and/or impaired glucose tolerance or elevated glycated haemoglobin (HbA1c). The Royal Australian College of General Practitioners (RACGP) guidelines for diagnosis using oral glucose tolerance test (or HbA1c) recognise the importance of extending diagnosis beyond simply identifying diabetes. This is relevant in view of the risk of composite cardiovascular events, coronary heart disease, stroke, and all-cause mortality associated with abnormal blood glucose. Since the pilot population mirrors this morbidity, the aviation regulator has an obligation to consider the impact in terms of aviation safety. Furthermore, although primary care literature predominantly focusses on the importance of diagnosing diabetes, from a regulator’s perspective there are incapacitation risks originating outside that narrow diagnosis. They arise once the control of glucose has begun to deteriorate. This article considers the regulatory importance of pilots and controllers who present with hyperglycaemia, or what is sometimes termed “prediabetes”. This includes the evidence for the risk assessment to help minimise the likelihood of an adverse event due to atherosclerotic cardiovascular disease among those holding aviation medical certificates, in turn promoting aviation safety.</p></abstract>

Obesity, the disease of the twenty-first century, has a range of serious consequences to health. These are related in part to abnormal glucose levels, resulting in inflammatory and atherogenic response, hypertension and abnormal lipid profile. This increases the risk of cardiovascular disease significantly besides developing diabetes later. Hyperglycaemia is diagnosed with impaired fasting glucose and/or impaired glucose tolerance or elevated glycated haemoglobin (HbA1c). The Royal Australian College of General Practitioners (RACGP) guidelines for diagnosis using oral glucose tolerance test (or HbA1c) recognise the importance of extending diagnosis beyond simply identifying diabetes. This is relevant in view of the risk of composite cardiovascular events, coronary heart disease, stroke, and all-cause mortality associated with abnormal blood glucose. Since the pilot population mirrors this morbidity, the aviation regulator has an obligation to consider the impact in terms of aviation safety. Furthermore, although primary care literature predominantly focusses on the importance of diagnosing diabetes, from a regulator’s perspective there are incapacitation risks originating outside that narrow diagnosis. They arise once the control of glucose has begun to deteriorate. This article considers the regulatory importance of pilots and controllers who present with hyperglycaemia, or what is sometimes termed “prediabetes”. This includes the evidence for the risk assessment to help minimise the likelihood of an adverse event due to atherosclerotic cardiovascular disease among those holding aviation medical certificates, in turn promoting aviation safety.

PREDIABETES AND THE NEED FOR CARDIOVASCULAR RISK ASSESSMENT IN AVIATION

Journal of the Australasian Society of Aerospace Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

{"article-title":"PREDIABETES AND THE NEED FOR CARDIOVASCULAR RISK ASSESSMENT IN AVIATION"}

Obesity, the disease of the twenty-first century, has a range of serious consequences to health. These are related in part to abnormal glucose levels,...

Aviation Authority	Diagnosis to be established	Tests to establish the diagnosis
ICAO	Diabetes	Oral glucose tolerance test (OGTT)
CASA	Abnormal glucose metabolism and cardiac risk	Fasting plasma glucose, OGTT, Cardiac risk index
Federal Aviation Authority (FAA)	Diabetes	Supporting Laboratory findings
Civil Aviation Authority, UK	Abnormal metabolism	Tests to establish abnormal glucose metabolism
European Aviation Safety Authority	Diabetes	OGTT
Transport Canada	Diabetes	Fasting plasma glucose, or HbA1c, or OGTT, or random plasma glucose
Civil Aviation Authority, New Zealand	Abnormal glucose metabolism	Acceptable biochemical criteria

	Impaired Fasting Glucose (IFG) (95% CI^* in parentheses)	Impaired Glucose Tolerance (IGT) (95% CI in parentheses)
a. Risk for non-fatal CVD outcome
(i) Annualised risk estimates for any nonfatal CVD event	0.63 – 9.68	11.58 – 12.39
(ii) Unadjusted annualised relative risk	1.24 (1.08 – 1.43) to 1.41 (1.17 – 1.69)	2.43 (1.44 – 4.10) to 2.46 (1.46 – 4.12)
(iii) Attributable risk in the exposed group	0% – 32.9%	52.8% – 52.9%
b. Risk for fatal CVD outcome
(i) Annualised risk per 100 persons in the exposed groups	01.10 – 1.54	0.06 – 0.76
(ii) Unadjusted annualised relative risk	1.32 (1.04 – 1.72)	1.67 (1.23 – 2.26) to 3.08 (1.47 – 6.47)
(iii) Attributable risk in the exposed group.	11.8% – 39.5%	24.8% – 67.3%
c. Risk for mortality
(i) Annualised risk per 100 persons in the exposed groups	0.56 – 1.39	0.09 – 2.44
(ii) Unadjusted annualised relative risk	1.18 (1.03 – 1.35) to 1.45 (1.27 – 1.66)	1.36 (1.12 – 1.66) to 3.18 (1.79 – 5.63)
(iii) Attributable risk in the exposed group	13.9% – 61.2%	0% – 67.2%

PREDIABETES AND THE NEED FOR CARDIOVASCULAR RISK ASSESSMENT IN AVIATION

Article Category: position-paper

Published Online: Dec 20, 2018

Page range: 1 - 7

DOI: https://doi.org/10.21307/asam-2018-007

© 2018 Sanjiv Sharma., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Risk Assessment Criteria for Abnormal Glucose Metabolism as followed by CASA and other jurisdictions

Risk estimates for cardiovascular disease among those with abnormal glucose tolerance test (Modified from Santaguida et. al. [30])