Metabolic and endocrinology guidance material GM

1. Applicants with metabolic, nutritional or endocrine dysfunction may be assessed as fit subject to demonstrated stability of the medical condition and satisfactory aero-medical evaluation.
2. Diabetes mellitus
   1. Applicants with diabetes mellitus requiring insulin shall be assessed as unfit.
   2. Applicants with diabetes mellitus not requiring insulin shall be assessed as unfit unless it can be demonstrated that blood sugar control has been achieved and is stable.
3. Aero-medical assessment
   1. Applicants for a class 1 medical certificate requiring medication other than insulin for blood sugar control shall be referred to the medical assessor of the licensing authority.
   2. The fitness of applicants for a class 2 medical certificate requiring medication other than insulin for blood sugar control shall be assessed in consultation with the medical assessor of the licensing authority.

CLASS 1 - AMC1 MED.B.025

(a) Metabolic, nutritional or endocrine dysfunction
Applicants with metabolic, nutritional or endocrine dysfunction may be assessed as fit if the condition is asymptomatic, clinically compensated and stable with or without replacement therapy, and regularly reviewed by an appropriate specialist.

CLASS 2 - AMC2 MED.B.025

(a) Metabolic, nutritional or endocrine dysfunction
Applicants with metabolic, nutritional or endocrine dysfunction should be assessed as unfit. A fit assessment may be considered if the condition is asymptomatic, clinically compensated and stable.

CLASS 1 - AMC1 MED.B.025

(b) Obesity
Applicants with a Body Mass Index greater than or equal to 35 may be assessed as fit only if the excess weight is not likely to interfere with the safe exercise of the applicable licence(s) and the results of a risk assessment, including evaluation of the cardiovascular system and evaluation of the possibility of sleep apnoea, are satisfactory.

CLASS 2 - AMC2 MED.B.025

(b) Obesity
Applicants with a Body Mass Index greater than or equal to 35 may be assessed as fit only if the excess weight is not likely to interfere with the safe exercise of the applicable licence(s) and the results of a risk assessment, including evaluation of the cardiovascular system and evaluation of the possibility of sleep apnoea, are satisfactory.

CLASS 1 - AMC1 MED.B.025

(c) Addison’s disease
Applicants with Addison’s disease should be assessed as unfit. A fit assessment with an OML may be considered, provided that cortisone is carried and available for use whilst exercising the privileges of the applicable licence(s).

CLASS 2 - AMC2 MED.B.025

(c) Addison’s disease
Applicants with Addison’s disease may be assessed as fit provided that cortisone is carried and available for use whilst exercising the privileges of the applicable licence(s).

CLASS 1 - AMC1 MED.B.025

(d) Gout
Applicants with acute gout should be assessed as unfit. A fit assessment may be considered once asymptomatic, after cessation of treatment or the condition is stabilised on anti-hyperuricaemic therapy.

CLASS 2 - AMC2 MED.B.025

(d) Gout
Applicants with acute gout should be assessed as unfit until asymptomatic.

CLASS 1 - AMC1 MED.B.025

(e) Thyroid dysfunction
Applicants with hyperthyroidism or hypothyroidism should be assessed as unfit. A fit assessment may be considered when a stable euthyroid state is attained.

CLASS 2 - AMC2 MED.B.025

(e) Thyroid dysfunction
Applicants with thyroid disease may be assessed as fit once a stable euthyroid state is attained

CLASS 1 - AMC1 MED.B.025

(f) Abnormal glucose metabolism
Glycosuria and abnormal blood glucose levels require investigation. A fit assessment may be considered if normal glucose tolerance is demonstrated (low renal threshold) or impaired glucose tolerance without diabetic pathology is fully controlled by diet and regularly reviewed.

CLASS 2 - AMC2 MED.B.025

(f) Abnormal glucose metabolism
Glycosuria and abnormal blood glucose levels require investigation. A fit assessment may be considered if normal glucose tolerance is demonstrated (low renal threshold) or impaired glucose tolerance is fully controlled by diet and regularly reviewed.

CLASS 1 - AMC1 MED.B.025

(g) Diabetes mellitus
Subject to good control of blood sugar with no hypoglycaemic episodes:

(1) applicants with diabetes mellitus not requiring medication may be assessed as fit;

(2) the use of antidiabetic medications that are not likely to cause hypoglycaemia may be acceptable for a fit assessment with an OML

CLASS 2 - AMC2 MED.B.025

(g) Diabetes mellitus
Applicants with diabetes mellitus may be assessed as fit. The use of antidiabetic medications that are not likely to cause hypoglycaemia may be acceptable.

Benign Pituitary Tumours Class 1 and 2

Applicants with symptoms and/or on first diagnosis should be assessed as unfit.

A fit assessment can be considered subject to a satisfactory endocrinologist’s report and visual fields assessment after 3 months of being stable on treatment.

Annual follow-up with endocrinology report and visual fields is required.

Cabergoline is used for the treatment of microprolactinomas. It is acceptable for any class of certification, providing the pilot has been stabilised on this medication for a period of not less than three months on the ground and has no adverse side-effects from the therapy.

Obesity

Guidance on obesity and treatments is available in the Information sheet for pilots and air traffic controllers and in the section on GLP-1 agonists on this page.

There is also information on the Medical Flight Test - Musculoskeletal.

Aeromedical assessment of applicants prescribed GLP-1 agonists for obesity

GLP-1 receptor agonists given subcutaneously are compatible with all classes of certification (Class 1/2/3/LAPL). Oral formulations are not presently compatible due to the high potential variability in absorption profile.

Available certification: Unrestricted Class 1/2/3/LAPL.

Initiation: Applicants should be made unfit for a period of at least 2 weeks upon starting treatment. A subsequent fit assessment should be made by an aeromedical examiner (AME) which includes confirmation of no side effects that could impair aeromedical fitness (including gastrointestinal upset, dizziness and mental health difficulties).

Dose adjustment: Unfit for at least 72 hours. AME assessment not required for return to flying and/or controlling.

Monitoring: As per obesity follow up requirements in the Information sheet for pilots and air traffic controllers.

Thyroid Dysfunction Class 1 and 2

Download UK CAA Guidance on Thyroid Dysfunction (PDF)

Abnormal Glucose Metabolism Class 1 and 2

Glycosuria should always be investigated with a minimum of random blood sugar. Symptomatic individuals should have an oral glucose tolerance test.

Class 1 applicants with impaired glucose tolerance should be reviewed annually.

Download the UK CAA Diabetes certification guidance and the Protocol for pilots treated with insulin and/or potentially hypoglycaemic medication

Download the Diabetes Briefing Sheet for certificate holders

Download Pilots Diabetes Operational/Medical Flight Test Report 

Download information about the Diabetes Report Specification