The U.S. FAA has developed a new medical protocol that paves the way for people with diabetes to seek airline transport or commercial pilot flying privileges. A notice published in today’s Federal Register reverses the agency’s long-standing policy that limited persons with insulin-treated diabetes mellitus (ITDM) to third-class medical certificates that were granted under a special-issuance, case-by-case basis.

“Previously available medical science, treatment, and monitoring have allowed the FAA to safely provide special-issue third-class medical certificates for private pilot privileges since 1996, but was not sufficient to meet the higher levels of safety demanded for applicants considered for airline transport or commercial pilot duties,” the agency said.

But advancements in medical science, including the ability for continuous glucose monitoring, make “it possible to mitigate flight safety risk so that applicants seeking first- or second-class special-issuance medical certification may be considered for the exercise of either airline transport or commercial pilot privileges.”

The FAA opted for the change after consulting with the American Diabetes Association, which recommend that FAA update its policy to reflect current diabetes medicine. An ADA expert panel concluded, “There are pilots with insulin-treated diabetes whose risk of incapacitation in flight is equivalent to, or lower than pilots who do not have insulin-treated diabetes. Their risk, like the risk presented by pilots who do not have insulin-treated diabetes, is nonzero, but extremely improbable.”

After studying the current protocol, as well as the safety record of commercial and ATP pilots permitted to fly with diabetes in the UK and Canada, the FAA developed a new protocol that accounted for the updates in glucose monitor and other medical treatments. Under the policy, individuals with ITDM can apply for a special issuance for any class of medical certificates if they follow the new protocol. Those seeking third-class certificates can continue to use the previous protocol or opt for the new protocol.

The FAA is accepting comments on the notice through January 6.