Diabetes mellitus is one of the most common diseases that poses a health and flight safety threat to pilots. Complications secondary to diabetes mellitus, such as cardiovascular and cerebrovascular disease can cause long-term disability and lead to sudden incapacitation. In Japan Air Self-Defense Force (JASDF), all pilots ages 40 or over undergo diabetes-related testing during an annual aeromedical examination. The purpose of this study is to analyze fasting blood sugar (FBS) changes, cardiovascular and cerebrovascular factors, and insulin resistance and secretory capacity to make blood glucose management more effective in JASDF pilots between 40 and 50 years old. Subjects were 454 JASDF pilots over 40 years old who had aeromedical examinations in Aeromedical laboratory between 2003 and 2017. The subjects were classified into Normal group (< 100 mg/dL, n = 356), High-normal group (100–119 mg/dL, n = 84), and Abnormal group (≥120 mg/dL, n = 14) according to FBS at 40 years old. We investigated the following three aspects to establish more effective blood glucose management in JASDF pilots. a) Age-related changes in FBS between 40 and 50 years old. b) At 40 years old., following eight items on cardiovascular and cerebrovascular factors; Body Mass Index (BMI), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), non- High-Density Lipoprotein Cholesterol (non-HDL), High-Density Lipoprotein cholesterol (HDL), Low-Density Lipoprotein cholesterol (LDL), Triglyceride (TG), and Uric Acid (UA). c) At 40 years old, Hemoglobin A1c (HbA1c), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), Homeostasis Model Assessment of β-cell function (HOMA-β), Abdominal Circumference (AC), and following three items on lifestyle; smoking rate, alcohol consumption, and physical activity. With regard to age-related changes in FBS, Normal group showed a significant increase from 41 to 50 years old compared to 40 years old, but remained below 100 mg/dL until 50 years old. High-normal group showed no significant difference after 41 years old compared to 40 years old, and remained 100–105 mg/dL until 50 years old. Abnormal group was highest at 40 years old, then decreased significantly from 41 to 48 years old, and remained 100–105 mg/dL until 49 years old, but reached 105 mg/dL or higher at 50 years old. In item of BMI, SBP, DBP, non-HDL, HDL, LDL, TG, and UA at 40 years old, all except for LDL in abnormal group were within the normal range. LDL in abnormal group was mildly abnormal. In item of HbA1c, HOMA-IR, HOMA-β, and AC at 40 years old, both Normal and High-normal group were within the normal range. There were no significant differences between the both groups. As for lifestyle at 40 years old, both Normal (19.3%) and High-normal group (42.9%) has high smoking rate. Both groups were in good shape, with physical activity above the standard and alcohol consumption below the standard. Although JASDF pilots had good glycemic control on aeromedical examination, we recommend the addition of effort targets for FBS (100 mg/dL or less) and guidance on smoking cessation as a means of strengthening management from a young age for more effective blood glucose management.

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