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Hyperglycaemia Initial Assessment flowchart long description

Hyperglycaemia - Initial Assessment flowchart (long description)

This description relates to the Hyperglycaemia - Initial Assessment flowchart image. The flowchart identifies those applicants with an elevated cardiovascular risk on account of abnormal glucose metabolism.

The CASA testing schedule begins with the assessment of fasting blood glucose.

If the fasting blood glucose is less than 5.5 mmol/L no further action is required and, provided there are no other issues, routine certification should take place.  In the first instance that   fasting blood glucose is equal to, or greater than, 5.5 mmol/L then an Oral Glucose Tolerance Test should be performed.

If the two hour glucose level is less than 7.8 mmol/L, the applicant is diagnosed with Impaired Fasting Glucose. In cases of Impaired Fasting Glucose the Designated Aviation Medical Examiner should undertake a Cardiovascular Disease Assessment which involves calculating a Coronary Risk Score. Calculation of a Coronary Risk Score will require results of a fasting cholesterol and high density lipoprotein test. The Coronary Risk Score should have an additional 3 points added to account for the presence of Impaired Fasting Glycaemia. If the Coronary Risk Score is greater than 14 an exercise stress test will also be required.

If the two hour glucose level is between 7.8 and 11 mmol/L, the applicant is diagnosed with Impaired Glucose Tolerance. In cases of Impaired Glucose Tolerance the Designated Aviation Medical Examiner should undertake a Cardiovascular Disease Assessment which involves calculating a Coronary Risk Score. Calculation of a Coronary Risk Score will require results of a fasting cholesterol and high density lipoprotein test. The Coronary Risk Score should have an additional 3 points added to account for the presence of Impaired Glucose Tolerance. If the Coronary Risk Score is greater than 14 an exercise stress test will also be required.

If the two hour glucose level is greater than 11 mmol/L the applicant is diagnosed with Diabetes Mellitus. In cases of Diabetes Mellitus the Designated Aviation Medical Examiner should refer to the Clinical Practice Guidelines for the Diabetes Schedule.

The flowchart describes surveillance of applicants diagnosed with Impaired Fasting Glucose and Impaired Glucose Tolerance in subsequent years following their initial diagnosis.

Applicants previously diagnosed with Impaired Fasting Glucose will be required to undertake Glycosylated Haemoglobin (HbA1c%) at their next assessment. This will be required at 12 months for class 1 and class 3 applicants and at 24 months for class 2 applicants. In all cases the Designated Aviation Medical Examiner should undertake a Cardiovascular Disease Assessment which involves calculating a Coronary Risk Score. Calculation of a Coronary Risk Score will require results of a fasting cholesterol and high density lipoprotein test. The Coronary Risk Score should have an additional 3 points added to account for the presence of Impaired Fasting Glucose. If the Coronary Risk Score is greater than 14 and exercise stress test will also be required.

Applicants previously diagnosed with Impaired Glucose Tolerance will be required to undertake Glycosylated Haemoglobin (HbA1c%) at their next assessment. This will be required at 12 months for class 1 and class 3 applicants and at 24 months for class 2 applicants. In all cases the Designated Aviation Medical Examiner should undertake a Cardiovascular Disease Assessment which involves calculating a Coronary Risk Score. Calculation of a Coronary Risk Score will require results of a fasting cholesterol and high density lipoprotein test. The Coronary Risk Score should have an additional 3 points added to account for the presence of Impaired Glucose tolerance. If the Coronary Risk Score is greater than 14 an exercise stress test will also be required.

The flowchart requires the same process to be repeated at each review unless:

  • the Glycosylated Haemoglobin (HbA1c%) is in the diabetic range. In these cases the diabetes protocol should be followed.
  • the Oral Glucose Tolerance Test is in the diabetic range. In these cases the diabetes protocol should be followed.
  • the Glycosylated Haemoglobin (HbA1c%) AND the Oral Glucose Tolerance Test fall within the normal range. In these cases the applicant can exit the flowchart and there are no additional requirements