Diabetic Pilots Get FAA Green Light Without Extra Reviews
Published Date: 9/4/2026
Proposed Rule
Summary
FAA proposes to amend its regulations to allow applicants with non-insulin dependent diabetes mellitus to apply for airman medical certification that may be issued at the time of their medical examination instead of requiring Special Issuance review by FAA. This action would reduce the burden associated with the process of review for Authorization for Special Issuance while recognizing that modern medical advancements have significantly improved the manageability of certain forms of diabetes.
Analyzed Economic Effects
5 provisions identified: 4 benefits, 0 costs, 1 mixed.
Estimated Industry Cost Savings Over Five Years
FAA estimates the proposed rule would save industry between about $39.70 million (low-case) and $80.19 million (high-case) in labor-hours over a five-year analysis period; FAA also provides discounted figures (e.g., $34.78 million at a 7% discount rate for the low case and $70.24 million at a 7% discount rate for the high case). These savings come from reduced pilot grounding and faster certification processing.
AMEs May Issue Certificates for NIDDM
The FAA proposes to remove the phrase "or any other hypoglycemic drug" from 14 CFR Sec. 67.113(a), 67.213(a), and 67.313(a). If finalized, people with non-insulin dependent diabetes mellitus (NIDDM) who meet other medical rules could get a first-, second-, or third-class airman medical certificate from an Aviation Medical Examiner (AME) at their exam, instead of being deferred to the FAA Special Issuance (SI) process. Applicants who use insulin (insulin-treated diabetes mellitus, ITDM) would still need to use the SI process.
Thousands of Cases Would Be Expedited
FAA estimates about 3,000 NIDDM cases per year could receive medical certificates at the time of the exam instead of being deferred. The agency also estimates roughly 1,200 recertification cases could transition from FAA review to AME handling, and as of September 2025 there were 1,300 initial applications in the FAA Medical Appeals queue of which about 300 would potentially qualify for AME issuance.
FAA Found Little Evidence of NIDDM Causing Accidents
FAA reviewed fatal accident data from 2008 through 2025 and found 51 cases where non-insulin diabetes medications were reported; in 50 of those cases FAA deemed it improbable that diabetes, complications, or diabetes medications contributed to the accident, and one case remains under investigation. FAA uses this analysis to support that streamlining NIDDM processing will not meaningfully increase risk.
No New Applicant Costs; Documentation Still Required
FAA states the proposed process would not impose new cost burdens on applicants with NIDDM; applicants would still provide the same documentation, typically a clinical progress note or status report from their treating physician and a Hemoglobin A1C (A1C) test performed no more than 90 days before the AME exam. AMEs will evaluate stability and may defer higher-risk cases to FAA.
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