Managing diabetes at the end of life - a retrospective chart audit of two health providers in Queensland, Australia

• Published in: Progress in palliative care Vol. 27; no. 2; pp. 51 - 57
• Main Authors: Alqabandi, Naeema, Haywood, Alison, Kindl, Korana, Khan, Sohil, Good, Phillip, Hardy, Janet
• Format: Journal Article
• Language: English
• Published: Taylor & Francis 04-03-2019
• Subjects: Diabetes; End of life; Insulin; Palliative care
• ISSN: 0969-9260; 1743-291X
• DOI: 10.1080/09699260.2019.1611721

Diabetes at the end of life (EoL) is characterized by blood glucose fluctuations that result from decreased oral intake, side effects of medications, altered physiology, and end-stage organ failure. With limited life expectancy and the presence of comorbidities, diabetes management can be challenging. While there is little clinical evidence to guide decision-makers, current practice depends on empiric and expert recommendations.
To evaluate the current prescribing patterns and monitoring parameters in diabetes management at the EoL in patients at two palliative care inpatient units.
Retrospective clinical chart review.
Adult patients attending the Palliative and Supportive Care Services at St Vincent's Private Hospital and Mater Adults Hospital, South Brisbane, Australia over a 24-month period, from October 2014 to October 2016.
A total of 145 charts were analysed. 139 patients were identified as having received glucose-lowering therapy (51% female, median age 71 years). Insulin therapy was used in 74 (51%) patients and oral and/or non-insulin therapies in 62 (43%). Blood glucose level monitoring was carried out a median of 4 times, range 1-6 times daily. Either continuously or at some stage of their treatment, 74 patients were receiving corticosteroids.
Insulin therapy appears to be the safest and most effective approach, taking into consideration the patient needs and pharmacodynamic profile of each preparation. Without evidence-based guidelines on the optimal intervention to control diabetes at the EoL, therapy plans must be individualized to prevent symptomatic hyper- and hypoglycaemia with minimal patient discomfort and adverse drug reactions.