WEBVTT 00:00:00.000 --> 00:00:03.960 Within our project we have two different aspects to consider. 00:00:04.400 --> 00:00:08.880 One is how is diabetes technology performing in the air? 00:00:09.120 --> 00:00:13.520 So are there any effects of pressure changes to the insulin delivery? 00:00:13.800 --> 00:00:15.000 Are the glucose monitors 00:00:15.000 --> 00:00:17.440 maybe not performing as well as on the ground levels? 00:00:18.000 --> 00:00:23.120 And of course, diabetes is not a disease that just affects the glucose 00:00:23.120 --> 00:00:27.840 and is just having problems when hypo- and hyperglycaemia occur, 00:00:28.200 --> 00:00:33.840 but also people with uncontrolled or not so well-controlled diabetes 00:00:33.840 --> 00:00:38.880 have other conditions such as cardiovascular disease, 00:00:39.400 --> 00:00:41.400 or eye disease, or kidney disease. 00:00:46.560 --> 00:00:48.200 Hello, my name is Julia Mader, 00:00:48.200 --> 00:00:50.480 I'm Professor of Diabetes Technology 00:00:50.480 --> 00:00:53.280 at Medical University of Graz in Austria. 00:00:53.280 --> 00:00:56.840 I'm here to present to you one of my EU projects, 00:00:57.200 --> 00:00:59.440 the so-called EASA Diabetes Project, 00:00:59.440 --> 00:01:02.520 where we look into diabetes and aviation safety. 00:01:02.760 --> 00:01:08.160 As we know, there is a lack in staff for various areas in the world. 00:01:08.200 --> 00:01:12.640 And also, as you can imagine, training people to become pilots 00:01:12.640 --> 00:01:15.640 and also air traffic controllers is expensive. 00:01:15.720 --> 00:01:20.760 So in that setting, airliners are happy if they can keep their staff 00:01:21.080 --> 00:01:26.840 once they have gone through that long and also expensive training. 00:01:26.840 --> 00:01:30.960 This is one of the reasons why EASA is funding the project 00:01:30.960 --> 00:01:34.040 that should help to overcome 00:01:34.040 --> 00:01:37.480 a shortage in both pilots and air traffic controllers. 00:01:42.080 --> 00:01:46.320 Within Europe, we do have varying regulations 00:01:46.320 --> 00:01:49.760 when it comes to aviation and diabetes. 00:01:50.360 --> 00:01:51.720 In the majority of countries, 00:01:51.720 --> 00:01:55.040 it is not allowed to become or remain a pilot 00:01:55.400 --> 00:01:58.280 when a person has diabetes. 00:01:58.280 --> 00:02:02.200 The same is true for air traffic controllers, also called ATCOs. 00:02:03.600 --> 00:02:07.120 In recent years, a safety protocol was developed 00:02:07.280 --> 00:02:10.160 that allowed pilots to remain pilots 00:02:10.160 --> 00:02:13.160 once they developed diabetes. 00:02:13.200 --> 00:02:16.320 And that protocol was implemented 00:02:16.320 --> 00:02:19.400 in Austria, the UK, and Ireland. 00:02:19.840 --> 00:02:22.880 And under this very strong and strict regulation, 00:02:22.880 --> 00:02:27.880 people who have diabetes can still fly aeroplanes 00:02:27.880 --> 00:02:29.520 when they were licensed 00:02:29.520 --> 00:02:33.640 before they had the manifestation of the condition. 00:02:33.640 --> 00:02:36.440 These people are of course of special interest 00:02:36.440 --> 00:02:38.360 when it comes to aviation safety, 00:02:38.360 --> 00:02:42.080 because, as you can imagine, both hypo- and hyperglycaemia 00:02:42.080 --> 00:02:45.360 can negatively affect the performance of people 00:02:45.360 --> 00:02:49.640 when they are flying or controlling aeroplanes in the sky. 00:02:49.640 --> 00:02:54.080 Because of that, they have to undergo medical exams 00:02:54.080 --> 00:02:59.400 at regular intervals and meet safety criteria that excel 00:02:59.440 --> 00:03:03.640 what we nowadays ask people with diabetes to achieve. 00:03:07.760 --> 00:03:09.520 What we do know is 00:03:09.520 --> 00:03:14.600 that the newer agents have a reduced risk of hypoglycaemia. 00:03:14.880 --> 00:03:18.440 When we think of diabetes therapy 10, 15 years back, 00:03:18.440 --> 00:03:21.440 we had metformin, sulfonylureas and insulin. 00:03:21.800 --> 00:03:26.880 Nowadays, we do have a real big bundle of medications, 00:03:27.160 --> 00:03:31.280 so for example SGLT2 inhibitors and GLP-1 receptor agonists, 00:03:31.720 --> 00:03:32.960 that can be used in type 2 diabetes 00:03:32.960 --> 00:03:36.800 and have a very low risk of hypoglycaemia, 00:03:37.120 --> 00:03:40.760 because one of the main risks, of course, is acute incapacitation 00:03:40.960 --> 00:03:43.880 due to hypoglycaemia whilst flying a plane. 00:03:44.000 --> 00:03:46.840 Also for people with type 1 diabetes, 00:03:46.840 --> 00:03:50.600 we have new players on the market. 00:03:50.600 --> 00:03:56.440 Namely, we have continuous glucose monitors with alarm function, 00:03:56.440 --> 00:04:00.760 so that can help us to early detect hypo- or hyperglycaemia 00:04:00.760 --> 00:04:03.640 so that the person can react appropriately. 00:04:04.240 --> 00:04:07.520 And we also have automated insulin delivery systems 00:04:07.520 --> 00:04:09.560 that can stop insulin delivery 00:04:09.560 --> 00:04:14.200 when hypoglycaemia is at risk to becoming true, 00:04:14.200 --> 00:04:18.000 or, on the other hand, when people go into hyperglycaemia, 00:04:18.000 --> 00:04:22.080 insulin delivery will be automatically adjusted and increased 00:04:22.080 --> 00:04:24.680 to get back the people to the normal range. 00:04:28.720 --> 00:04:31.840 The evidence was evidence from everyday life. 00:04:32.240 --> 00:04:36.360 And within the project, we need to see how these medications 00:04:36.360 --> 00:04:41.040 and how these technologies affect people who are pilots 00:04:41.040 --> 00:04:43.520 or people who are air traffic controllers. 00:04:43.840 --> 00:04:47.840 Within our project, we have two different aspects to consider. 00:04:48.320 --> 00:04:52.760 One is how is diabetes technology performing in the air? 00:04:53.000 --> 00:04:57.440 So are there any effects of pressure changes to the insulin delivery? 00:04:57.720 --> 00:04:58.920 Are the glucose monitors 00:04:58.920 --> 00:05:01.360 maybe not performing as well as on the ground? 00:05:01.360 --> 00:05:04.800 And of course, diabetes is not a disease 00:05:04.800 --> 00:05:06.840 that just affects the glucose and 00:05:07.280 --> 00:05:11.240 is just having problems when hypo- and hyperglycaemia occur, 00:05:11.560 --> 00:05:17.040 but also people with uncontrolled or not so well-controlled diabetes 00:05:17.040 --> 00:05:22.240 have other conditions, such as cardiovascular disease, 00:05:22.760 --> 00:05:25.520 or eye disease, or kidney disease. 00:05:25.520 --> 00:05:28.600 When it comes to type 1 diabetes and type 2 diabetes, 00:05:28.640 --> 00:05:31.800 of course there are differences, especially when it comes also 00:05:31.800 --> 00:05:34.960 to cardiovascular disease and cardiovascular risk. 00:05:35.360 --> 00:05:37.920 For that reason, our project 00:05:37.920 --> 00:05:41.160 collaborates with another project funded by the EASA, 00:05:41.160 --> 00:05:44.200 which is called the Cardiovascular Disease Project. 00:05:45.000 --> 00:05:47.840 And we have regular meetings with this group 00:05:47.840 --> 00:05:51.720 to really have alignment in our recommendations. 00:05:52.520 --> 00:05:57.160 We definitely need to screen for these at certain intervals in pilots, 00:05:57.480 --> 00:06:01.160 because all of the comorbidities could of course 00:06:01.160 --> 00:06:06.000 adversely affect people whilst doing their duty 00:06:06.000 --> 00:06:07.520 in the aeroplane or in the tower. 00:06:11.560 --> 00:06:15.280 The clinical trial was done in October 2024. 00:06:16.120 --> 00:06:20.360 We are expecting the outcome of the project in October 2025 00:06:20.400 --> 00:06:23.880 and hopefully these data will then be integrated 00:06:23.880 --> 00:06:28.720 into the new regulation that EASA will release. 00:06:28.920 --> 00:06:33.440 What we can expect is that more technologies 00:06:33.440 --> 00:06:37.760 will be acknowledged within the EASA protocol, 00:06:37.760 --> 00:06:41.080 because so far it is not foreseen that 00:06:41.080 --> 00:06:45.160 people whilst flying are using automated insulin delivery, 00:06:45.600 --> 00:06:49.040 but it is expected to be on manual mode. 00:06:49.600 --> 00:06:50.800 And number two, 00:06:50.800 --> 00:06:53.560 that people also can rely on their glucose sensor data, 00:06:53.800 --> 00:06:57.160 because nowadays that current protocol requires 00:06:57.160 --> 00:07:00.160 fingerprick measurements and documenting the fingerpricks 00:07:00.440 --> 00:07:05.360 by voice commands into the speech recorder of the aeroplane.