Verde Paola, Piccardi Laura, Gentile Sandro, Roberts Graham A, Mambro Andrea, Pepe Sofia, Strollo Felice
Aerospace Medicine Department, Aerospace Test Division, Mario De Bernardi AFB, Pratica di Mare, 00071 Rome, Italy.
Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy.
Biomedicines. 2025 Aug 30;13(9):2125. doi: 10.3390/biomedicines13092125.
Following the recent publication of reassuring outcomes from the ARA MED 330 protocol regarding long-term insulin use in pilots, combined with continuous advancements in diabetes technology, European aeromedical examiners are increasingly optimistic about establishing more flexible medical requirements for insulin-treated aviation professionals. These professionals have historically been considered unfit for duty due to hypoglycemic risks. According to current research, hypoglycemia, the primary incapacitation risk for flight crew, is considered virtually non-existent among air traffic controllers (ATCOs). Additionally, stress-induced hyperglycemia also represents a low-frequency risk in these professionals, who are experienced in managing highly stressful operational environments. This study presents a narrative review examining stress and its metabolic effects in healthy individuals, ATCOs, and people with diabetes (PwD). This narrative review was conducted based on a comprehensive PubMed search performed by two independent reviewers (GAR and AM) spanning January 2023 to January 2025. The search strategy focused on English-language, peer-reviewed studies involving human participants and addressed stress, glucose regulation, and occupational factors in ATCOs and people with diabetes. Additional relevant articles were identified through reference screening. A total of 33 studies met the inclusion criteria. Studies focusing solely on oxidative or molecular mechanisms were excluded from the analysis. Stressful events consistently triggered the expected hyperglycemic reaction in both healthy individuals and PwD. However, the literature indicates ATCOs demonstrate remarkable stress resilience and adaptation to the demanding conditions of their work environment, suggesting a unique occupational profile regarding metabolic stress responses. These findings contribute valuable insights to ongoing discussions regarding aeromedical fitness standards. The evidence suggests that ATCOs may not face the same metabolic risks as flight crews, indicating that current medical certification processes for insulin-treated aviation professionals warrant reconsideration in light of this emerging evidence. This research supports the potential for more individualized, occupation-specific aeromedical standards that better reflect the actual risk profiles of different aviation roles.
随着ARA MED 330方案近期公布了关于飞行员长期使用胰岛素的令人安心的结果，再加上糖尿病技术的不断进步，欧洲航空医学检查员对于为接受胰岛素治疗的航空专业人员制定更灵活的医学要求越来越乐观。由于低血糖风险，这些专业人员在历史上一直被认为不适合履职。根据目前的研究，低血糖是飞行机组人员主要的失能风险，而空中交通管制员（ATCO）中几乎不存在这种情况。此外，应激性高血糖在这些专业人员中也是低频风险，因为他们有在高压力操作环境中工作的经验。本研究进行了一项叙述性综述，考察健康个体、ATCO和糖尿病患者（PwD）的应激及其代谢影响。这项叙述性综述基于两位独立审稿人（GAR和AM）在2023年1月至2025年1月期间进行的全面PubMed搜索。搜索策略聚焦于涉及人类参与者的英文、同行评审研究，并探讨了ATCO和糖尿病患者的应激、血糖调节及职业因素。通过参考文献筛选确定了其他相关文章。共有33项研究符合纳入标准。仅关注氧化或分子机制的研究被排除在分析之外。应激事件在健康个体和PwD中均持续引发预期的高血糖反应。然而，文献表明，ATCO表现出显著的应激恢复力，并能适应其工作环境的苛刻条件，这表明在代谢应激反应方面他们具有独特的职业特征。这些发现为正在进行的关于航空医学健康标准的讨论提供了有价值的见解。证据表明，ATCO可能不会面临与飞行机组人员相同的代谢风险，这表明鉴于这一最新证据，目前针对接受胰岛素治疗的航空专业人员的医学认证程序值得重新考虑。这项研究支持了制定更个性化、针对特定职业的航空医学标准的可能性，这些标准能更好地反映不同航空角色的实际风险概况。
