SGLT2 inhibitors

The FAA's diabetes disposition table says that for diabetes treated with one or more non-insulin diabetic medications the examiner should defer and submit the information to the FAA, and that the initial special issuance requires an FAA decision.

The FAA's AME Assisted Special Issuance page for type II diabetes controlled by medication says that, once the FAA has granted the Authorization, examiners may re-issue a medical certificate under it, provided the applicant does not require insulin, remains on an acceptable oral medication therapy according to the chart of acceptable combinations, and provides the documents it lists. Under medication adjustment, when the dose or formulation is changed or a different drug within the same class is started, the chart lists a 48-hour observation within Groups B to G.

The FAA documents quoted here address SGLT2 inhibitors only as diabetes medication; taken for another condition, such as heart failure or kidney disease, that condition's own FAA guidance applies and is not covered here.

• 30 days after starting: ground observation

FAA rule for diabetes medication: The FAA makes the initial certification decision and the examiner must defer; combinations of up to three non-insulin medications, only one from each group, are considered acceptable, with an observation period when starting one. Each component in a combination medication is counted separately (for example, rosiglitazone + metformin counts as 2 medications), 4 or more medications may be considered on a case-by-case basis, and for unlisted medications the chart says to consult AMCD or RFS. Under medication adjustment, the chart lists 48 hours within Groups B to G, 7 days within Group A2, 7 days within Group A1 if a new type of insulin is added (with a note that no time is needed for a minor dose change within the same drug class), and 7 days if transitioning between insulin injection to or from a pump, or for new insulin/CGM devices. The FAA's diabetes disposition table says that for diabetes treated with one or more non-insulin diabetic medications the examiner should defer and submit the information to the FAA, and that the initial special issuance requires an FAA decision. The FAA's AME Assisted Special Issuance page for type II diabetes controlled by medication says that, once the FAA has granted the Authorization, examiners may re-issue a medical certificate under it, provided the applicant does not require insulin, remains on an acceptable oral medication therapy according to the chart of acceptable combinations, and provides the documents it lists. For insulin, the chart says to see Medical Certification Using Insulin, and for starting or adding insulin it gives separate lines for third-class pilots or agency ATCS and for first- or second-class pilots, who must use the CGM protocol; insulin has its own entry, which asks for the class of medical. FAA, Acceptable Combinations of Diabetes Medications