FAA proposal to simplify diabetes medical certification for non-insulin-treated pilots could speed approvals and reduce costs

The Federal Aviation Administration has proposed easing medical certification rules for pilots with controlled non-insulin diabetes, potentially accelerating approvals and cutting costs for thousands of applicants while maintaining safety standards.

The Federal Aviation Administration has proposed loosening medical certification rules for pilots whose diabetes is controlled with non-insulin drugs, a move that could remove a long-running administrative hurdle for thousands of applicants and speed up approvals for first-, second- and third-class medical certificates.

According to the FAA, aviation medical examiners would be able to issue certificates at the time of examination in many of these cases rather than sending applications through the agency’s Special Issuance process. The agency said the current framework, which dates back to 1959, reflects an older era of diabetes treatment and no longer matches modern care, in which a wider range of medicines has helped reduce the risk of severe complications such as hypoglycaemia and cardiovascular events.

The proposal would not affect pilots who use insulin, who would still need Special Issuance authorisation. But it would shift many pilots using non-insulin treatment into the FAA’s ordinary medical standards review, provided they meet the safety requirements. The agency estimated the change could allow examiners to approve about 3,000 cases a year immediately and move another 1,200 cases away from Special Issuance review, potentially saving applicants between $39.7 million and $80.2 million over five years in labour costs.

The FAA also said it reviewed 51 fatal accidents from 2008 through 2025 involving pilots reported to be taking non-insulin diabetes medication. It concluded that diabetes, related complications or the medication itself were unlikely to have played a role in 50 of the accidents, with one still under investigation. Comments on the proposal will be accepted for 30 days after publication in the Federal Register.