Prescription Patterns and Monitoring Parameters in Managing Diabetes at the End of Life
Embargoed until: 2019-05-10
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Background Diabetes is a common chronic disorder, the prevalence of which has increased substantially in the past decade with significant burden of illness to the patient, carers and society. Diabetes management in terminally ill patients is complex and challenging and it is one of the common co-morbidities seen in the terminal phase of life. With limited life expectancy, co-morbid conditions and high medication burden, diabetes management becomes more challenging in this population. The evidence base to inform practice on diabetes management outcomes at end of life is weak. The current practice is predominantly empiric with over reliance on expert opinion. The goal of treatment is limited to the prevention of hypoglycaemia and osmotic symptoms caused by elevated blood sugar levels, rather than intensified prevention of diabetes-related long-term complications. The limited evidence based protocols emphasise individualising the glycaemic control plan according to the patient’s need with the goal to improve the quality of life and to eliminate patient discomfort. In patients with type 1 diabetes, insulin is essential for life and discontinuation may lead to a critical life-threatening state crisis. However, there are many insulin preparations with questionable pharmacodynamics profiles. There is no agreement on the optimal insulin type to be used in type 1 diabetics.
Master of Medical Research (MMedRes)
School of Medical Science
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