In terminal illness careful control to avoid long-term complications is not required. Management of diabetes during terminal illness will not only depend on the type of diabetes, but also on prognosis, oral intake and the presence of co-existing disease such as renal and hepatic impairment.
All dietary restrictions relating to diabetes are removed from the early stage of terminal illness. In both T1DM and T2DM, glucose monitoring should be reduced to an acceptable minimum. In the case of a patient treated with insulin, this may be 2–3 times per week and for a patient treated with oral agent’s blood glucose could be monitored 1–2 times per week., only in case of special situation frequent monitoring is advisable. This may include: hypoglycaemia, poor food intake, nausea and vomiting, enteral or parenteral feeding or corticosteroid use. The clear aim is to avoid hypoglycaemia and osmotic symptoms, so the recommendations suggest a target blood glucose range between 10 and 15 mmol/l in the early stage of terminal illness with a more liberal range of 5–20 mmol/l in the later stages.
Subsequently there are no agreed, evidence-based strategies to manage diabetes at the end of life or during terminal illness.
Therefore, in this review I will try to uncover some of the challenges and discuss the available guidelines associated with managing diabetes at the end of life and terminal illness from the available scientific evidence.
King, E. J., H. Haboubi, D. Evans, I. Baker, S. C. Bain, and J. W. Stephens. "The management of diabetes in terminal illness related to cancer", QJM, 2012.
Rowles S, Kilvert A, Sinclair A et al. ABCD position statement on diabetes and end of life care. Pract Diab Int Jan/Feb 2008 Vol.28 No.1.
McCoubrie R, Jeffrey D, Paton C, Dawes L. Managing diabetes mellitus in patients with advanced cancer: a case note audit and guidelines. Eur J Cancer Care 2005; 14:244-8.
Poulson J. The management of diabetes in patients with advanced cancer. J Pain Symptom Manage 1997; 13:339-46.
Kilpatrick ES, Rigby AS, Atkin SL. The Diabetes control and complications trial: the gift that keeps giving. Nat Rev Endocrinol 2009; 5:537-545.
Garcia TJ, Brown S A et al. The Diabetes Educator 2011; 37:167-187.
Alderman MH. New onset diabetes during antihypertensive therapy. Am J Hypertens 2008; 21:493-9
Angelo M, Ruchalski C, Spronge BJ. An approach to diabetes mellitus in hospital and palliative medicine. J Palliate Med 2011; 14:83-7.
Boyd K. Diabetes Mellitus in hospice patients: some guidelines. Palliate Med 1993; 7(2): 163-4.
Custódio, J.S., Roriz-Filho, J., Cavalcanti, C.A.J. et al. Use of SGLT2 Inhibitors in Older Adults: Scientific Evidence and Practical Aspects. Drugs Aging 37, 399–409 (2020).
Ford-Dunn S, Smith A, Quin J. Management of diabetes during the last days of life: attitudes of consultant diabetologists and consultant palliative care physicians in the UK. Palliat Med 2006; 20: 197-203.
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