Setting occupational standards for insulin-treated diabetes at sea, on land and in the air

Diabetes, particularly treatment with insulin, has proved a longstanding and frustrating barrier to employment in certain occupations where public safety has been deemed to be potentially at risk. Historically, health and safety issues within the work environment have dictated employment policy, precluding people with diabetes who would otherwise be entirely capable of undertaking required responsible and skilled activities. Such considerations have been especially evident for professional occupations involving both commercial and public transport on land, by sea and in the air. This situation is changing. With the combination of individualised diabetes management and implementation of the Disability Discrimination Act, it is no longer appropriate to apply a 'blanket ban' restriction to employment irrespective of circumstances. The UK Maritime and Coastguard Agency (MCA), the Driving and Vehicle Licensing Agency (DVLA) and the Civil Aviation Authority (CAA) have each accepted the principle that insulin-treated diabetes should no longer be an absolute contraindication to occupational employment, but to be potentially permissable subject to strict, robust individual assessment. Each transport agency has established regulatory standards and operational protocols appropriate for their respective domains with a prime emphasis on minimising hypoglycaemia risk. Ensuring public safety remains paramount, but, with these protocol surveillance and assessment processes in place, it has proved possible for individuals with insulin-treated diabetes to achieve fitness certification and gain employment previously excluded to them. Over the last few years, despite having diabetes and being treated with insulin, many merchant seafarers, drivers of heavy goods vehicles and commercial airline pilots have successfully achieved fitness accreditation to work safely and reliably within these special occupational situations. Copyright (C) 2015 John Wiley & Sons.