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Improving Diabetes Care for Hospice Patients.
Sei J Lee1, Margaret A Jacobson2, C Bree Johnston3
1Division of Geriatrics, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA sei.lee@ucsf.edu.
The American Journal of Hospice & Palliative Care
|April 9, 2015
Summary
Hospice patients with type 2 diabetes often receive overly aggressive glucose control, increasing hypoglycemia risk. Recommendations include discussing medication adjustments and targeting blood glucose levels between 200-300 mg/dL.
Area of Science:
- Gerontology
- Endocrinology
- Palliative Care
Background:
- Type 2 diabetes guidelines suggest less aggressive glycemic control for patients with limited life expectancy.
- Hospice patients frequently continue glucose-lowering medications, elevating hypoglycemia risk.
Purpose of the Study:
- To identify reasons for overly tight glycemic control in hospice patients.
- To propose strategies for optimizing diabetes management in end-of-life care.
Main Methods:
- Qualitative analysis of barriers to medication adjustment.
- Review of historical quality indicators (HEDIS) for glycemic control.
- Development of evidence-based recommendations for hospice glycemic management.
Main Results:
- Barriers include uncomfortable medication discussions, patient/family beliefs about hyperglycemia symptoms, and past HEDIS measures.
- Proposed target blood glucose range: 200-300 mg/dL.
- HEDIS measures for glycemic control now exclude hospice patients.
Conclusions:
- Adjusting diabetes medication regimens is crucial for hospice patients.
- Implementing proposed recommendations can reduce hypoglycemia and improve quality of life.
- Provider education on updated HEDIS measures is essential.
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