Glycated Hemoglobin vs. Fasting Glucose in Routine Screening of Military Aircrew

INTRODUCTION: Diabetes screening is crucial in aviation medicine because of its impact on flight safety. This study compared the diagnostic performance of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) in Polish Air Force pilots ages 45 yr and older and assessed their role in optimizing screening protocols. Additionally, the study examined the relationships between age, body mass index (BMI), body fat percentage, and prediabetes or diabetes prevalence in this population. METHODS: This study included 175 military flight personnel who were undergoing periodic medical examinations. Individuals with diagnosed diabetes were excluded. FPG, HbA1c, age, BMI and body fat percentage were measured. A multivariate regression model was used to examine their associations. RESULTS: Among 175 male pilots ages 45-60 yr (M = 50.05, SD = 3.74), 68.6% had normal HbA1c, 30.3% were prediabetic, and 1.1% were diabetic. FPG classified 43.4% of the subjects as normal, 53.1% as prediabetic, and 3.4% as diabetic. A normal BMI was found in 23.4% of the subjects, whereas a normal body fat percentage occurred in 37%. Regression revealed that body fat percentage was more strongly associated with HbA1c than was age or BMI. DISCUSSION: HbA1c testing has proven to be a practical and cost-effective tool for detecting abnormal glucose metabolism in military aircrew, particularly when used alongside FPG. Its implementation has reduced the need for further testing and may streamline periodic evaluations. Additionally, body fat percentage emerged as a more reliable predictor of dysglycemia than BMI was, suggesting the value of including body composition assessments in routine screenings. Kurek MA, Kwiatkowski F, Popiela D, Biernacki M, Gaździńska A, Rola M. Glycated hemoglobin vs. fasting glucose in routine screening of military aircrew. Aerosp Med Hum Perform. 2026; 97(3):169-175.