Introduction. This project summarizes current information on the risks associated with diabetes mellitus and its medical management amongst aviation personnel. Methods. A literature review was accomplished looking at aviators with diabetes mellitus along with a literature review of the common medications used to treat type 2 diabetes. Results. Several aeromedical agencies do allow pilots with diabetes to operate aircraft, even if they require medical management to include oral or injectable medications for good control of their disease. In general, however, pilots with type 1 diabetes are restricted to non-military, non-transport duties and pilots with type 2 diabetes are more common. The risk for sudden incapacitation is the greatest concern and is increased for a number of medications commonly used to treat diabetes. Discussion. Each aeromedical agency sets it own standards regarding waiver requirements and the information presented in this project represents a general summary of these requirements. Type 2 diabetes is becoming increasingly prevalent in the aviation community and aeromedical examiners need to be aware of current clinical practice guidelines to ensure that aviators with diabetes remain at low risk for developing sudden incapacitation.