Within our project we have two different aspects to consider. One is how is diabetes technology performing in the air? So are there any effects of pressure changes to the insulin delivery? Are the glucose monitors maybe not performing as well as on the ground levels? And of course, diabetes is not a disease that just affects the glucose and is just having problems when hypo- and hyperglycaemia occur, but also people with uncontrolled or not so well-controlled diabetes have other conditions such as cardiovascular disease, or eye disease, or kidney disease. Hello, my name is Julia Mader, I'm Professor of Diabetes Technology at Medical University of Graz in Austria. I'm here to present to you one of my EU projects, the so-called EASA Diabetes Project, where we look into diabetes and aviation safety. As we know, there is a lack in staff for various areas in the world. And also, as you can imagine, training people to become pilots and also air traffic controllers is expensive. So in that setting, airliners are happy if they can keep their staff once they have gone through that long and also expensive training. This is one of the reasons why EASA is funding the project that should help to overcome a shortage in both pilots and air traffic controllers. Within Europe, we do have varying regulations when it comes to aviation and diabetes. In the majority of countries, it is not allowed to become or remain a pilot when a person has diabetes. The same is true for air traffic controllers, also called ATCOs. In recent years, a safety protocol was developed that allowed pilots to remain pilots once they developed diabetes. And that protocol was implemented in Austria, the UK, and Ireland. And under this very strong and strict regulation, people who have diabetes can still fly aeroplanes when they were licensed before they had the manifestation of the condition. These people are of course of special interest when it comes to aviation safety, because, as you can imagine, both hypo- and hyperglycaemia can negatively affect the performance of people when they are flying or controlling aeroplanes in the sky. Because of that, they have to undergo medical exams at regular intervals and meet safety criteria that excel what we nowadays ask people with diabetes to achieve. What we do know is that the newer agents have a reduced risk of hypoglycaemia. When we think of diabetes therapy 10, 15 years back, we had metformin, sulfonylureas and insulin. Nowadays, we do have a real big bundle of medications, so for example SGLT2 inhibitors and GLP-1 receptor agonists, that can be used in type 2 diabetes and have a very low risk of hypoglycaemia, because one of the main risks, of course, is acute incapacitation due to hypoglycaemia whilst flying a plane. Also for people with type 1 diabetes, we have new players on the market. Namely, we have continuous glucose monitors with alarm function, so that can help us to early detect hypo- or hyperglycaemia so that the person can react appropriately. And we also have automated insulin delivery systems that can stop insulin delivery when hypoglycaemia is at risk to becoming true, or, on the other hand, when people go into hyperglycaemia, insulin delivery will be automatically adjusted and increased to get back the people to the normal range. The evidence was evidence from everyday life. And within the project, we need to see how these medications and how these technologies affect people who are pilots or people who are air traffic controllers. Within our project, we have two different aspects to consider. One is how is diabetes technology performing in the air? So are there any effects of pressure changes to the insulin delivery? Are the glucose monitors maybe not performing as well as on the ground? And of course, diabetes is not a disease that just affects the glucose and is just having problems when hypo- and hyperglycaemia occur, but also people with uncontrolled or not so well-controlled diabetes have other conditions, such as cardiovascular disease, or eye disease, or kidney disease. When it comes to type 1 diabetes and type 2 diabetes, of course there are differences, especially when it comes also to cardiovascular disease and cardiovascular risk. For that reason, our project collaborates with another project funded by the EASA, which is called the Cardiovascular Disease Project. And we have regular meetings with this group to really have alignment in our recommendations. We definitely need to screen for these at certain intervals in pilots, because all of the comorbidities could of course adversely affect people whilst doing their duty in the aeroplane or in the tower. The clinical trial was done in October 2024. We are expecting the outcome of the project in October 2025 and hopefully these data will then be integrated into the new regulation that EASA will release. What we can expect is that more technologies will be acknowledged within the EASA protocol, because so far it is not foreseen that people whilst flying are using automated insulin delivery, but it is expected to be on manual mode. And number two, that people also can rely on their glucose sensor data, because nowadays that current protocol requires fingerprick measurements and documenting the fingerpricks by voice commands into the speech recorder of the aeroplane.