FAA proposes easing medical certification rules for diabetic pilots

The Federal Aviation Administration (FAA) has proposed a rule that would allow applicants with non-insulin dependent diabetes mellitus (NIDDM) to obtain an airman medical certificate at the time of their medical examination, rather than being deferred to the agency for Special Issuance (SI) review. The notice of proposed rulemaking, published in the Federal Register of September 4, 2026 (Vol. 91, No. 171, Proposed Rules, p. 56798), would amend 14 CFR Part 67 and is open for public comment until October 5, 2026.

The proposal, docketed as FAA–2026–10990 (Notice No. 26–15, RIN 2120–AM25), is titled “Modernizing Medical Standards for Non-Insulin Dependent Diabetes Mellitus Cases.” It would remove the phrase “or any other hypoglycemic drug” from the general medical standards in §§ 67.113(a), 67.213(a), and 67.313(a), which govern first-, second-, and third-class medical certificates. The contact for the rulemaking is Dr. Charles Mathers of the FAA Office of Aerospace Medicine.

What the rule would change

Under current rules, an applicant with a clinical diagnosis of diabetes requiring insulin or any other hypoglycemic drug for control has a specifically disqualifying medical condition and must go through the Authorization for Special Issuance of a Medical Certificate (SI) process under § 67.401. The proposed rule would instead let NIDDM applicants be evaluated by an Aviation Medical Examiner (AME) under the general medical standards in paragraphs (b) and (c) of the relevant sections.

• NIDDM would no longer be a specifically disqualifying condition.
• Applicants with insulin-treated diabetes mellitus (ITDM) would still be required to use the SI process.
• An AME may still defer higher-risk NIDDM cases to FAA medical personnel for further evaluation.
• Applicants would continue to provide a clinical progress note and an acceptable Hemoglobin A1C (A1C) test.

Safety and cost analysis

The FAA reviewed fatal accidents involving airmen using non-insulin diabetes medications from 2008 to 2025, drawing on its ToxDB databases. Of 51 cases identified, it deemed it improbable that diabetes, its complications, or its medications contributed to the accident in 50 cases; one case remains under investigation.

The agency estimates the change would let AMEs issue certificates at the time of the exam in roughly 3,000 cases annually, and would transition about 1,200 cases currently followed under SI to AME handling. Over a five-year analysis period, the FAA projects 44,176 unrestricted NIDDM certifications and industry cost savings of $39.70 million in a low-case scenario and $80.19 million in a high-case scenario.

Background

The diabetes disqualification standard dates to 1959, when the agency barred certification for diabetes requiring insulin or other hypoglycemic drugs over concerns about unpredictable hypoglycemia. The FAA later relaxed the policy through a 1982 final rule, a 1996 policy allowing oral-hypoglycemic applicants, and a 2019 announcement extending first- and second-class issuance to some insulin-treated pilots. The agency argues that modern treatments, including SGLT2 inhibitors and GLP-1 receptor agonists, have substantially reduced diabetic complications and that the SI process burdens both applicants and its own medical staff.

If finalized, the rule would shorten wait times and reduce backlogs for well-controlled NIDDM applicants, allowing the FAA to focus its medical resources on higher-risk cases and expanding the pool of pilots eligible to hold airman medical certificates.

Source: Federal Register, Vol. 91, No. 171, September 4, 2026, Proposed Rules, p. 56798 (official reference: Docket No. FAA–2026–10990, RIN 2120–AM25, 14 CFR Part 67).