A1C Prediabetes

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a1c5.8

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I currently hold a 1st class medical. On my latest blood test, my a1c came back as 5.8. I was "prescribed" diet and exercise and not put on any medication. My understanding is that currently there is nothing for me to report and I do not need to self-ground, is that correct?

What do I need for my next medical exam? Looking at the prediabetes deposition table, it shows prediabetes treated ONE diabetic medication (non-insulin) component require a CACI and detailed clinical and progress note. What about if only treated with lifestyle intervention?

Thanks in advanced!
 
You don't have diabetes and you're not on any medication. Unless you are aware of something else that you believe would negatively impact your ability to safely and effectively fly an aircraft, there's nothing to report. Just use it as a wake up call to take a hard look at your diet and exercise regimen, and don't let that A1c climb to the point you meet criteria for diagnosis.
 
Actually that's incorrect. You have diabetes controlled by diet and exercise, which is not an issue for AME authority to issue.
 
How does he have diabetes with a single A1c of 5.8? He doesn't meet any of the ADA diagnostic criteria.
 
Does the agency use ADA? Thnik about that. They were auth'd in 2008-9 to write their own definitions....good luck with that.
 
bbchien said:
Does the agency use ADA? Thnik about that. They were auth'd in 2008-9 to write their own definitions....good luck with that.
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Please direct me to where they have done so. The AME guide says "A medical history or clinical diagnosis of diabetes mellitus may be considered previously established when the diagnosis has been or clearly could be made because of supporting laboratory findings and/or clinical signs and symptoms." The history provided by OP does not meet ADA standards (or any medical standard, to my knowledge) for a diagnosis of diabetes, nor does it meet the verbiage in the AME guide. Unless there's a history of hypoglycemic symptoms or an A1c of at least 6.5% that you're aware of beyond what OP posted, I fail to see how the FAA guidelines support your assertion.

If you want to argue that he has prediabetes (barely, but agree), that's a different matter and is clearly delineated in the prediabetes CACI guidance. But I take exception to telling someone that they have diet-controlled diabetes when the provided history and lab result do not support that diagnosis. That could send someone down an incorrect path, surely.

Edit: And I want to make clear that I know you're a very senior AME, and I show due respect for that. Either it was a misstatement (and I've made plenty of those myself) or I have a fundamental misunderstanding of what the FAA considers the diagnostic criteria for diet-controlled diabetes. If the latter, I'm genuinely asking for direction as to where I can find those standards, as I can't find them myself and I don't see how he could be diagnosed any other way.
 
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a1c5.8 said:
I currently hold a 1st class medical. On my latest blood test, my a1c came back as 5.8. I was "prescribed" diet and exercise and not put on any medication. My understanding is that currently there is nothing for me to report and I do not need to self-ground, is that correct?

What do I need for my next medical exam? Looking at the prediabetes deposition table, it shows prediabetes treated ONE diabetic medication (non-insulin) component require a CACI and detailed clinical and progress note. What about if only treated with lifestyle intervention?

Thanks in advanced!
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I was prescribed a certain diet and exercise due to A1C of somewhat higher than yours, and high blood lipid levels.
The good old "Mediterranean diet" is oft prescribed; our house went that way, with the modification of turkey and fish allowed.
I've lost 25 lbs, and I don't portion control. The S/O's blood lipids went from poor to excellent.
I go in for my update shortly.
Diet is more important than exercise. I feel great. (Despite the high-grade prostate cancer thing; that's up next.)
 
AvNavCom said:
Please direct me to where they have done so. The AME guide says "A medical history or clinical diagnosis of diabetes mellitus may be considered previously established when the diagnosis has been or clearly could be made because of supporting laboratory findings and/or clinical signs and symptoms." The history provided by OP does not meet ADA standards (or any medical standard, to my knowledge) for a diagnosis of diabetes, nor does it meet the verbiage in the AME guide. Unless there's a history of hypoglycemic symptoms or an A1c of at least 6.5% that you're aware of beyond what OP posted, I fail to see how the FAA guidelines support your assertion.

If you want to argue that he has prediabetes (barely, but agree), that's a different matter and is clearly delineated in the prediabetes CACI guidance. But I take exception to telling someone that they have diet-controlled diabetes when the provided history and lab result do not support that diagnosis. That could send someone down an incorrect path, surely.

Edit: And I want to make clear that I know you're a very senior AME, and I show due respect for that. Either it was a misstatement (and I've made plenty of those myself) or I have a fundamental misunderstanding of what the FAA considers the diagnostic criteria for diet-controlled diabetes. If the latter, I'm genuinely asking for direction as to where I can find those standards, as I can't find them myself and I don't see how he could be diagnosed any other way.
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You missed a critical line. It does not affect the AME's ability to issue. This is an FAA distinction without a difference.
 
bbchien said:
You missed a critical line. It does not affect the AME's ability to issue. This is an FAA distinction without a difference.
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FAA distinction for issuance, sure. But I don't want OP walking away thinking he has a diagnosis of diabetes when he doesn't, either by FAA or conventional standards. Obviously this is something that his PCM and AME should make clear, but it's an important point.
 
bbchien said:
Does the agency use ADA? Thnik about that. They were auth'd in 2008-9 to write their own definitions....good luck with that.
Click to expand...

bbchien said:
Actually that's incorrect. You have diabetes controlled by diet and exercise, which is not an issue for AME authority to issue.
Click to expand...

I'm curious...what would the FAA's perspective be if the OP goes onto a carnivore diet and after a time his hbA1C numbers drop well below the diabetes or pre-diabetes thresholds, and hold steady in the normal range?

My dad has type 2, and I was nudging that direction in the past. In my research, I had always been under the impression that it's not cureable. More lately though after getting into a rat hole of research on metobolic health, keto diet living, and specifically carnivore or primarily animal-based living that there are many cases of folks reversing their diabetes
 
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