Candidates having either type 1 or type 2 diabetes are considered unfit for entry into the armed forces. For those already serving in the armed forces, the first priority if diagnosed with either type of diabetes is always the full assessment, treatment and stabilization of their condition. All personnel suffering either type of diabetes mellitus should be referred to a Medical Board when a decision on their medical category1 will be made. Each case is considered on its merits.
Thereafter a decision is made on the continued employability of the person. Factors taken into account are:
The illness—its severity, its stability, the required treatment
The individual—their wishes, their motivation and commitment
Their service history—experience, trade, specialization
Their utility in a Service environment (once other factors have been considered)
Guidance on the appropriate medical category for personnel with diabetes mellitus is contained in the Joint Service Publication JSP 346. This states that:
“Clear differentiation should be made between those personnel suffering from insulin dependent (Type I) or non-insulin dependent (Type II) diabetes mellitus, and the respective risk levels with military service. For this reason all cases should be graded P31 or P71 when first diagnosed while their disorder is assessed. Following assessment, they are graded as follows:
a. Non-insulin dependent diabetes mellitus (NIDDM). Those suffering from NIDDM (i.e. asymptomatic glycosuria), controlled by diet or biguanide hypoglycaemic medication, with no other signs or risk factors present (e.g. a personal/family history of heart disease, stroke, other endocrine dysfunction, smoker, obesity, hyperlipidaemia, eye or renal disease etc.), and whose functional capacity is otherwise unaffected, may be graded P21. However, most in this category with anything other than asymptomatic glycosuria should be graded P31 or P71. This includes individuals on sulphonylurea hypoglycaemic medications which carry a risk of hypoglycaemia.
b. Insulin dependent diabetes mellitus (IDDM). Those with well controlled insulin dependent diabetes, with no other signs or risk factors present, and whose functional capacity is otherwise unaffected, may be graded P31,2 all others should be graded P71. ‘Brittle’ or poorly controlled diabetes which either degrades the functional capacity and, or is failing to respond satisfactorily to treatment, may require to be medically invalided (P81).
c. Special work problems and restrictions. For those with IDDM, if considered fit to continue work in the military. The following are recommended:
1. Avoidance of physically high-energy demanding activities or emergency type work.
2. Restricted aircrew, diving, seafaring duties etc.
3. Vocational Group 2 drivers are subject to individual assessment by DVLA, but are unlikely to be considered fit.
4. Shift work can be problematic; however, if sensible working practices are adopted, it is not absolutely contra-indicated.
5. All should be afforded easy access to both nutritional and medical supportive facilities."
In summary, the continued employment of personnel with diabetes mellitus is a complex issue that is determined on an individual basis. In practice, it is unusual for someone with type 1 diabetes to remain in the services. Those type 1 and type 2 diabetics who are retained will usually be in a reduced medical category with restrictions on their activities depending on the aforementioned factors. This can range from full duties on a ship where there is a medical officer on board or “base areas only” at the milder end of the disease spectrum to “home only” or “no sea service” at the more severe end.
1 Physical capacity (P) Definition
0—Medically unfit for duty and under medical care
2—Medically fit for unrestricted service worldwide
3—Medically fit for duty with minor employment limitations
Limited operational deployability subject to individual assessment
4—Medically fit for duty within the limitations of pregnancy
7—Medically fit for duty with major employment limitations
Medically unfit for operational deployment
8—Medically unfit for service
2 This is subject to individual circumstances and single services requirements.