Prediabetes

Your step-by-step plan

1. 1

   Step 1: Before you begin

   Whether you have ever had an A1C of 6.5% or greater, and what your medication is used for.

   This worksheet is for prediabetes, in a pilot who has never had an A1C of 6.5% or greater.

   It is not for

   • Not: Anyone who has ever had an A1C of 6.5% or greater
   • Not: Diabetes in remission (diet-controlled)
   • Not: Diabetes treated with medication, including insulin
   • Not: Diabetes insipidus

   Show the FAA's words: Before you begin

   If the applicant has EVER had an A1C OF 6.5% OR GREATER, DO NOT USE THIS CACI.

   FAA source: CACI – Prediabetes Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.

   AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA

   Medication is used for:

   Note: Diabetes in remission (diet-controlled), diabetes treated with medication (including insulin), or diabetes insipidus DO NOT qualify for this CACI.

   [ ] Prediabetes

   FAA source: CACI – Prediabetes Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.

2. 2

   Step 2: Progress note, A1C and status report form

   The records the examiner reviews, and what your treating doctor finds.Three things to bring

   • Progress note

     Within 90 days before the exam

     A current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.

     What your treating physician finds

     • The condition is stable
     • No symptoms or complications associated with diabetes
     • No side effects from the medication
     • No low blood sugar (hypoglycemic events: symptoms, or glucose 70 mg/dl or less) that required intervention in the past 12 months

   • A1C

     Within 90 days before the exam

     A current A1C, taken within the last 90 days.

     Result

     • 6.4% or lessCurrent A1C
     • Never 6.5% or greaterHistory

   • The status report form

     The FAA's Weight Loss Management or Prediabetes Status Report, filled in by the provider who prescribes your medication.

     The form asks for

     • The reason for the medication: prediabetes or hyperglycemia, or weight loss management
     • The dates of the last clinical encounter and of the most recent medication change
     • The A1C value and date, dated within 90 days of the exam
     • Any side effects from medications
     • Any low blood sugar episode (hypoglycemia) in the past year
     • Whether you take any form of insulin
     • Any clinical concerns
     • All current medications, for any condition

     Once it is filled in

     • A narrative, tests and the like attached for any YES answer
     • Returned to your AME, to upload into your FAA file

   Show the FAA's words: Progress note, A1C and status report form

   the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.

   FAA source: CACI – Prediabetes Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.

   Current A1C

   Note: A1C 6.5% or greater is diagnostic for diabetes (ADA).

   …Within last 90 days;

   6.4% or LESS; and

   No history ever of A1C 6.5% or greater

   FAA source: CACI – Prediabetes Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.

   This requires a current, detailed Clinical Progress Note from the treating physician and Hemoglobin A1c lab performed no more than 90 days before the AME exam.

   FAA source: Prediabetes Disposition Table. FAA date 27 September 2023; checked by Crosscheck 14 October 2026.

   WEIGHT LOSS MANAGEMENT or PREDIABETES STATUS REPORT

   …Please have the provider who prescribes your medication for weight loss or prediabetes enter the information in the space below.

   Return the completed status report to your AME to upload into your FAA file.

   Reason for taking this medication:

   Prediabetes/hyperglycemia

   Weight loss management

   Date of last clinical encounter

   Date of most recent MEDICATION change

   …Hemoglobin A1C lab value and date?

   A1C required only for prediabetes (dated within 90 days of the AME exam); enter n/a if medication is for weight loss only.

   …Any side effects from medications?

   …ANY episode of hypoglycemia in the past year?

   …Does this patient take ANY form of insulin?

   …Any clinical concerns?

   …List ALL current medications (for any condition).

   *If any YES answers, please attach narrative, tests, etc.

   FAA source: Weight Loss and Prediabetes Status Report. FAA date 29 April 2026; checked by Crosscheck 14 October 2026.

   Treating physician finds the condition is stable and NONE of the following are present:

   Symptoms or complications associated with diabetes;

   Side effects from the medication; and/or

   Hypoglycemic events (symptoms or glucose 70 mg/dl or less) which required intervention in the past 12 months

   FAA source: CACI – Prediabetes Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.

3. 3

   Step 3: Your medication

   The worksheet's medication list, and its observation periods.

   Only one of the medications the worksheet lists: metformin, liraglutide, semaglutide (Wegovy, by injection or oral) or tirzepatide (Zepbound).

   Observation periods

   • One weekAfter starting the medication
   • 48 hoursWith each dose increase, medication or formulation change

   Your AME should verify the one-week observation after starting.

   Show the FAA's words: Your medication

   ONLY ONE of the medications listed is used:

   AME should verify one-week observation after starting medication. (See Pharmaceuticals, Weight Loss Medication.) 48-hour observation with each dose increase, medication or formulation change.

   …Indicate which one medication is used:

   metformin OR

   liraglutide OR

   semaglutide* (Wegovy) OR

   tirzepatide (Zepbound)

   *injection or oral

   FAA source: CACI – Prediabetes Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.

4. 4

   Step 4: The separate metabolic syndrome protocol: a first Authorization

   The treating doctor's report, on which the FAA bases its decision.

   Only under the separate protocol for medication-controlled metabolic syndrome.

   Only under the separate protocol for medication-controlled metabolic syndrome.

   A report from your treating physician, with sufficient information to rule out diabetes mellitus.

   The AMCD makes the first Authorization decision; the AME may not.

   The report

   • The medication used and its dosage
   • Whether there are side effects or clinically significant low blood sugar (hypoglycemic) episodes
   • An indication of satisfactory control of the metabolic syndrome
   • An A1C from within the past 30 days

   Associated disease

   • Any cardiovascular, neurological, renal and/or ophthalmological disease, noted

   Not in itself disqualifying, but carefully evaluated for any added risk to aviation safety.

   Show the FAA's words: The separate metabolic syndrome protocol: a first Authorization

   Medication Controlled Metabolic Syndrome (Glucose Intolerance, Impaired Glucose tolerance, Impaired Fasting Glucose, Insulin Resistance, and Pre-Diabetes)

   …The initial Authorization determination will be made on the basis of a report from the treating physician. There must be sufficient information to rule out diabetes mellitus.

   …The initial Authorization decision is made by the AMCD and may not be made by the Examiner.

   FAA source: Guide for Aviation Medical Examiners – Medication Controlled Metabolic Syndrome. FAA date 26 July 2023; checked by Crosscheck 14 October 2026.

   For favorable consideration, the report must contain a statement regarding the medication used, dosage, the absence or presence of side effects and clinically significant hypoglycemic episodes, and an indication of satisfactory control of the metabolic syndrome. The results of an A1C hemoglobin determination within the past 30 days must be included.

   FAA source: Guide for Aviation Medical Examiners – Medication Controlled Metabolic Syndrome. FAA date 26 July 2023; checked by Crosscheck 14 October 2026.

   Note must also be made of the presence of cardiovascular, neurological, renal, and/or ophthalmological disease. The presence of one or more of these associated diseases will not be, per se, disqualifying but the disease(s) must be carefully evaluated to determine any added risk to aviation safety.

   FAA source: Guide for Aviation Medical Examiners – Medication Controlled Metabolic Syndrome. FAA date 26 July 2023; checked by Crosscheck 14 October 2026.