New guidance on caring for diabetes patients at end of life

The guidance is for nurses and other health and social care professionals who are not diabetes specialists but who are caring for people with diabetes during their last year of life.

“The special issues and challenges of diabetes can make this emotional time harder to manage for everyone involved”

Simon O’Neill

End-of-life care in people with diabetes can be complicated because of the many different types of treatment for glucose lowering that are used by people with type 1 and type 2 diabetes.

Good management of these treatments during a patient’s final months is important to ensure effective diabetes symptom control while reducing adverse treatment effects.

The new resource includes an algorithm with clear recommendations on when to adjust and withdraw diabetes treatments during end-of-life care.

It is an update on treatment guidelines issued by Diabetes UK in 2013.

The new guidance recommends that insulin therapy should never be stopped in patients with type 1 diabetes. A small once daily dose of long-acting insulin should be used in a patient’s last days.

Diabetes medications including insulin may be reduced or discontinued in patients with type 2 diabetes who wish to stop taking them, depending on the patient’s weight, appetite and glucose readings.

The guidance also recommends adjusting glucose targets during the final year of life to 6-15 millimoles per litre (mmol/l), and considering the use of continual glucose monitoring.

Co-chair of Trend Diabetes and independent consultant in diabetes nursing June James said that there was a dearth of guidelines, recommendations and research into end-of-life care in diabetes.

“Caring for people with diabetes as they approach the last year, month and days of life often falls to healthcare professionals who are not specialists in diabetes care, so it is important that clear clinical recommendations are accessible to promote good quality care,” she said.

Director of care and clinical intelligence at Diabetes UK Simon O’Neill said: “Managing diabetes is an added stress for those who are nearing the end of their life and for their families.

“The special issues and challenges of diabetes can make this emotional time harder to manage for everyone involved.

“These changes to recommendations provide health and social care professionals with a valuable resource to help improve the quality of care delivered to meet the personal preferences and priorities of those who are dying, their families and carers.”