Glycaemic control in end-of-life care

Diabetes mellitus is one of the most common comorbidities in palliative care. Yet, the optimal handling of diabetes mellitus in dying patients is debated. This review aims to discuss comprehensively the scientific basis as of today for diabetes mellitus management decisions in end-of-life (EOL) care.

Glycaemic control provides prognostic information in EOL care of diabetes mellitus patients. Original data on how to manage dying patients with type 2 diabetes mellitus are scarce. Findings in elderly type 2 diabetes mellitus patients and expert opinions support that glycaemic control should be relaxed in dying patients with type 2 diabetes mellitus, in the absence of risk factors for true insulin dependence, to avoid symptomatic hypoglycaemia.For terminal but conscious type 1 diabetes mellitus patients, regular blood glucose measurements and continued insulin therapy is the mainstay, with some discrepancy in preferred management between palliative care physicians and diabetes consultants. No randomized controlled trials are available.Improvement is clearly needed with regard to communication about diabetes mellitus in EOL and documentation of decisions.Corticosteroid-induced diabetes mellitus is a significant problem in palliative care, but predictors exist.

In the absence of large observational studies or randomized controlled trials, the current body of knowledge is based on expert opinions, surveys and retrospective studies. Nevertheless, some clinically meaningful recommendations can be made. Prospective studies need to be performed in order to improve our understanding about diabetes mellitus management in EOL. The palliative care community has a joint responsibility to address these questions.