World Diabetes Day 2025 

1. World Diabetes Day 2025 focuses on "Diabetes and the workplace" this year. Why does this theme resonate so strongly in safety-critical fields such as aviation? 

Julia Mader (JM): Aviation exemplifies why "diabetes in the workplace" matters. Pilots and air traffic con-trollers perform safety-critical tasks where brief periods of impaired cognitive function - for example from severe hypoglycaemia or marked hyperglycaemia -can have dispropor-tionate consequences. At the same time, many sectors already experience workforce shortages despite large investments in training, so preserving the ability of qualified staff to remain in post is an important economic and social aim. Evolving regulations in aviation can set rigorous, evidence-based precedents that translate into better workplace policies across many other professions.

2. What inspired the European Union Aviation Safety Agency (EASA) Diabetes Project, and how did aviation become an area of focus in diabetes research?

JM: The project grew from longstanding concerns and practical observations both from people with diabetes and early experimental work, suggesting that certain diabetes technologies might behave differently in changing cabin conditions. For example, earlier laboratory studies and case reports raised questions about whether pressure changes could cause transient over- or under-delivery of insulin pumps. Europe already has a few jurisdictions in Austria, the UK and Ireland that allow carefully regulated exceptions for licensed pilots with diabetes, which created a clear need to evaluate whether modern glucose sensors and automated insulin delivery systems are safe and reliable in flight. Thus, EASA funded a targeted Horizon project: to test devices under realistic conditions, characterise the risks, and generate the evidence that regulators and airlines need to up-date fitness protocols where appropriate.

3. How does the EASA Diabetes Project contribute to improving aviation safety for people living with diabetes?

JM: The project addresses safety in three complementary ways. First, it tests how devices perform in aviation relevant conditions. Second, it evaluates clinical outcomes and operational profiles of people using these technologies in real world settings, to assess whether device behaviour translates into meaningful risk. Third, the project aims to produce actionable outputs for regulators and clinicians. Together, these components create a pathway for safely recognising newer diabetes therapies and technologies within aviation protocols rather than excluding capable professionals by default.

4. Beyond glucose control, what other health factors does your project consider for aviation safety?

JM: Diabetes is more than short term glucose variability. For aviation safety we explicitly consider comorbidities and complications that can affect performance over time, notably cardiovascular disease, retinopathy and nephropathy and the influence of lifestyle fac-tors. Because cardiovascular risk differs between type 1 and type 2 diabetes and be-cause comorbid conditions can be asymptomatic yet performance relevant, our project works in close alignment with a parallel EASA funded cardiovascular project. This collaboration helps us define appropriate screening intervals, monitoring pathways and thresholds for referral so aeromedical examiners can reliably identify and manage risks beyond immediate glucose control.

5. What outcomes do you hope this research will achieve for pilots and air traffic controllers (ATCOs) living with diabetes?

JM: Our primary goal is evidence driven inclusion: to create a regulatory and clinical frame-work that allows qualified pilots and ATCOs to use modern diabetes therapies and technologies safely, where appropriate. Ultimately, we hope the research will reduce unnecessary career disruption, help preserve highly trained personnel, and set a rigorous, replicable model for other professions where precision and safety matter.

Looking Ahead

As we observe World Diabetes Day 2025, projects like the EASA Diabetes Project remind us that diabetes should not define professional limits. With innovation, evidence, and person-centred policy, people living with diabetes can reach new heights. In this case, encouraging precision, safety, and inclusion to coexist in the modern workplace makes ‘Diabetes and the workplace’ a reality for all.