Management of diabetes during air travel

A systematic literature review of current recommendations and their supporting evidence

James Pavela, Rahul Suresh, Rebecca Blue, Charles H. Mathers, Ligia Belalcazar

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Objective: Individuals with diabetes are increasingly seeking pretravel advice, but updated professional recommendations remain scant. We performed a systematic review on diabetes management during air travel to summarize current recommendations, assess supporting evidence, and identify areas of future research. Methods: A systematic review of the English literature on diabetes management during air travel was undertaken utilizing PubMed and MEDLINE. Publications regarding general travel advice; adjustment of insulin and noninsulin therapies; and the use of insulin pumps, glucometers and subcutaneous glucose sensors at altitude were included. Gathered information was used to create an updated summary of glucose-lowering medication adjustment during air travel. Results: Sixty-one publications were identified, most providing expert opinion and few offering primary data (47 expert opinion, 2 observational studies, 2 case reports, 10 device studies). General travel advice was uniform, with increasing attention to preflight security. Indications for oral antihyperglycemic therapy adjustments varied. There were few recommendations on contemporary agents and on nonhypoglycemic adverse events. There was little consensus on insulin adjustment protocols, many antedating current insulin formulations. Most publications advocated adjusting insulin pump time settings after arrival; however, there was disagreement on timing and rate adjustments. Glucometers and subcutaneous glucose sensors were reported to be less accurate at altitude, but not to an extent that would preclude their clinical use. Conclusion: Recommendations for diabetes management during air travel vary significantly and are mostly based on expert opinion. Data from systematic investigation on glucose-lowering medication adjustment protocols may support the development of a future consensus statement. Abbreviations: CSII = continuous subcutaneous insulin infusion (device) DPP-4 = dipeptidyl peptidase 4 EGA = error grid analysis GDH = glucose dehydrogenase GOX = glucose oxidase GLP1 = glucagon-like peptide-1 NPH = neutral protamine Hagedorn SGLT2 = sodium-glucose cotransporter-2.

Original languageEnglish (US)
Pages (from-to)205-219
Number of pages15
JournalEndocrine Practice
Volume24
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Air Travel
Insulin
Expert Testimony
Publications
Glucose
Sodium-Glucose Transport Proteins
Glucose 1-Dehydrogenase
Dipeptidyl Peptidase 4
Subcutaneous Infusions
Equipment and Supplies
Glucose Oxidase
Protamines
Glucagon-Like Peptide 1
Hypoglycemic Agents
PubMed
MEDLINE
Observational Studies
Therapeutics

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Management of diabetes during air travel : A systematic literature review of current recommendations and their supporting evidence. / Pavela, James; Suresh, Rahul; Blue, Rebecca; Mathers, Charles H.; Belalcazar, Ligia.

In: Endocrine Practice, Vol. 24, No. 2, 01.02.2018, p. 205-219.

Research output: Contribution to journalReview article

Pavela, James ; Suresh, Rahul ; Blue, Rebecca ; Mathers, Charles H. ; Belalcazar, Ligia. / Management of diabetes during air travel : A systematic literature review of current recommendations and their supporting evidence. In: Endocrine Practice. 2018 ; Vol. 24, No. 2. pp. 205-219.
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