FAA Proposes Easing Medical Approvals for Diabetic Pilots

The FAA today issued a notice of proposed rulemaking that would allow aviation medical examiners (AMEs) to evaluate and certify applicants with non-insulin-dependent diabetes mellitus (NIDDM) at the time of their medical exam, removing the automatic requirement for special-issuance review by the agency for many applicants. Public comments on the proposal are due October 5.

Under current regulations, an applicant with a medical history of diabetes requiring insulin “or any other hypoglycemic drug” is automatically disqualified and must go through the special-issuance process under FAR 67.401, and the Federal Air Surgeon then determines whether the applicant can perform their duties safely.

The proposed rule would replace the hypoglycemic-drug language with a standard that requires “no established medical history or clinical diagnosis of diabetes mellitus that requires insulin for control.” Insulin-treated diabetes would continue to require special-issuance review, and AMEs would retain discretion to refer higher-risk NIDDM cases to the FAA.

According to the FAA, the change reflects improvements in diabetes management since the current standard was adopted in 1959. In a review of 51 fatal accidents from 2008 to 2025 involving non-insulin diabetes medications, the FAA found diabetes-related factors an unlikely contributor in 50, with one still under investigation.

Roughly 3,000 applicants would receive certification annually without special-issuance deferral under the proposal, the FAA estimates. Combined industry and FAA cost savings over five years were projected at $39.70 million (low-case) to $80.19 million (high-case); the FAA’s share of those savings was estimated at about $835,000.