United States Department of Transportation
i
Vitreous Fluid and/or Urine Glucose Concentrations in 1,335 Civil Aviation Accident Pilot Fatalities
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2008-05-01
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[PDF-802.41 KB]
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Abstract:For aviation accident investigations at the Civil Aerospace Medical Institute (CAMI), vitreous fluid and urine samples from pilot fatalities are analyzed for glucose, and in those cases wherein glucose levels are elevated, blood hemoglobin A1c (HbA1c) is measured. These analyses are conducted to monitor diabetic pilots to ensure that their disease was in control at the time of accidents and to discover other pilots with undiagnosed and unreported diabetes. In this study, the prevalence of elevated glucose concentrations in fatally injured civilian pilots is evaluated. Glucose and HbA1c are measured by hexokinase and latex immunoagglutination inhibition methodologies, respectively. The former was adopted at the beginning of 1998, while the latter in the middle of 2001. The analytical results are electronically stored in the CAMI Toxicology Database. This database was searched for pilots from whom samples were received during 1998–2005 and whose vitreous fluid and/or urine glucose concentrations were measured. HbA1c levels and information on diabetic pilots were also retrieved. The probable cause and contributing factors of the associated accidents were obtained from the National Transportation Safety Board's (NTSB's) Aviation Accident Database. Out of 1,335 pilots involving 363 vitreous fluid, 365 urine, and 607 vitreous fluid and urine analyses, 43 pilots had elevated glucose in vitreous fluid (> 125 mg/dL) and/or in urine (> 100 mg/dL). Of the 20 pilots whose blood samples were analyzed, 9 had > 6% HbA1c—4 were known diabetics (HbA1c: 7.1; 8.3; 10.8; and 12.4%), and 5 were not known diabetics (HbA1c: 6.2; 8.2; 8.3; 8.6; and 13.0%). Urinary glucose levels were elevated in all 13 known hyperglycemic pilots. One pilot had a history of renal glycosuria (low renal threshold). The disease of the 13 diabetic pilots was not in control at the time of accidents. Additionally, there were a considerable number of pilots with elevated glucose (30 of 43) and HbA1c (5 of 20), suggesting undiagnosed and unreported diabetic conditions. However, health, medical condition(s), and use of medications (authorized or unauthorized) by pilots were determined by the NTSB to be the cause or a factor in 5 accidents: elevated glucose level of the pilot was a factor in 1 and incapacitation/impairment of the pilot was a cause and/or factor in 4. Greater attention is necessary in controlling diabetes by aviators in coordination with Aviation Medical Examiners.
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