Technological innovation of Continuous Glucose Monitoring (CGM) as a tool for commercial aviation pilots with insulin-treated diabetes and stakeholders/regulators: A new chance to improve the directives?

Civil aviation pilots who develop insulin-treated diabetes and want to renew a Commercial Pilot License (CPL) represent a medical, social and regulatory problem. This depends on justified concerns about hypoglycemia, the most threatening event for people who carry out jobs requiring a high level of concentration and reliability. This negatively affects social and working aspects of pilots' lives, who have a high profile and a high-cost professional qualification. It could be possible now to revise this attitude thanks to the availability of Continuous Glucose Monitoring (CGM) devices. CGM clearly showed to prevent hypoglycemic events in insulin-treated diabetic patients by allowing strict monitoring and trend prediction of glucose levels. By systematizing available data on such devices and present regulations in CPL issuance worldwide, our review can be used as handy tool for a fruitful discussion among the scientific community, national and international civil aviation regulators, stakeholders and pilots, aimed at evaluating the evidence-based opportunity to revise CPL issuance criteria for insulin-treated diabetic pilots. For the above-mentioned reasons, there are, among the regulatory administrations of Civil Aviation around the globe, several different approaches and limitations set for the subjects with insulin-treated diabetes who want to obtain, or renew, a CPL.

[Mortality in workers of a primary aluminum foundry in Portovesme in Sardinia]. / Mortalità nei lavoratori della fonderia di alluminio primario di Portovesme in Sardegna.

The standard mortality rates (SMRs) were calculated for 1148 workers of a primary aluminium plant in Portovesme, Sardinia, hired between 1971, when production started, and 1980. Status (living or decreased) was ascertained as at 31 December 1990 and the relationship between observed and expected deaths with respective 95% confidence limits were calculated on the basis of age-specific regional rates for each calendar year of the follow-up. The SMR for all causes was 81 with confidence limits between 61 and 108 based on a total of 48 deaths. Mortality due to malignant neoplasms did not differ from the expected rate. The observed deaths due to lung cancer were decidedly less than the expected number (3 observed versus 4.7 expected). A significant excess of cancer of the pancreas was observed with special reference to anode production, based, however, on only 3 observed cases against 0.8 expected. In the absence of a more precise definition of the causes of death, of the environmental exposure levels and of the non-occupational confounding factors, and considering the young age of the cohort under study, it is at present doubtful whether the excess of cancer of the pancreas can be associated with work in the primary aluminium industry. The results should therefore be taken as preliminary, indicating that further studies are required.