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• Report from the treating physician to confirm no complications of diabetes, including renal
and visual complications;
• Annual cardiovascular assessment such as a symptom limited exercise ECG and clinical
review by a cardiologist.
Follow-up should be agreed jointly between the treating physician and the medical assessor.
This approach could be extended to encompass pilots and air traffic control officers with Type 2 diabetes
on sulphonylureas as well as those on insulin. This would avoid any period of unfitness on
sulphonylureas with the resultant potential degradation in training.
Acknowledgements
Dr. Hugh O’Neill, Transport Canada
Dr. Warren Silberman, Federal Aviation Administration.
References to Annex 1
* C-peptide is an indicator of beta cell activity. Most Type 1 diabetics are C-peptide negative.
ICAO Preliminary Unedited Version — November 2009 III-4A2-3
1. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of
diabetes on the development and progression of long-term complications in insulin dependent diabetes
mellitus. N Engl J Med 1993; 329: 977-86.
2. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas
or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes
(UKPDS 33). Lancet 1998; 352: 837-53.
3. The DCCT Research Group. Hypoglycaemia in the diabetes control and complications trial. Diabetes
1997; 46: 271-86.
4. Gerich J F. Hypoglycaemia and counter regulation in type 2 diabetes. Lancet 2000; 356: 1946-47.
5. Heller S. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their
duration. Diabetologia 2007; 50(6): 1140-7.
6. Akram K, Pedersen-Bjergaard U, Carstensen B et al. Frequency and risk factors of severe hypoglycaemia
in insulin-treated Type 2 diabetes: a cross-sectional survey. Diabetic Medicine 2006; 23: 750-6.
————————
ICAO Preliminary Unedited Version — November 2009
Part III
Chapter 5. HAEMATOLOGY
Page
Introduction ............................................................................................... III-5-1
Anaemia ..................................................................................................... III-5-1
Glucose-6-Phosphate dehydrogenase (G6DP) deficiency ...................... III-5-2
Erythrocytosis (Polycythaemia) ............................................................... III-5-2
Acute leukaemia ........................................................................................ III-5-2
Chronic leukaemia .................................................................................... III-5-3
Lymphomas ............................................................................................... III-5-3
Bleeding and thrombotic disorders………………… ............................. III-5-3
Haemoglobinopathies ............................................................................... III-5-6
Sickling conditions ............................................................................... III-5-4
Sickle-cell disease ................................................................................ III-5-5
Sickle-cell trait ..................................................................................... III-5-5
References .................................................................................................. III-5-5
ICAO Preliminary Unedited Version — November 2009 III-5-1
INTRODUCTION
In the introductory chapters of this manual, the basic principles for the assessment of an applicant’s
medical fitness are outlined.
The general provisions of Annex 1, 6.2.2, state that an applicant shall be required to be free from any
abnormality, disability, etc., such as “would entail a degree of functional incapacity which is likely to
interfere with the safe operation of an aircraft or with the safe performance of duties.”
The fitness requirements referring specifically to haematology are detailed for Class I Medical
Assessment in Annex 1, 6.3.2.17 (and in the corresponding paragraphs of Chapter 6 for Class 2 and
Class 3 Medical Assessments).
6.3.2.17 Applicants with diseases of the blood and/or the lymphatic system shall be assessed as
unfit unless adequately investigated and their condition found unlikely to interfere with the safe
exercise of their licence and rating privileges.
Note.— Sickle cell trait or other haemoglobinopathic traits are usually compatible with a fit
assessment.
Applicants with haematological conditions should be considered on an individual basis depending on the
 
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