Managing diabetes at the end of life - a retrospective chart audit of two health providers in Queensland, Australia

Abstract

Background: Diabetes at the end of life (EoL) is characterized by blood glucose fluctuations that result from decreased oral intake, side effects of medications, altered physiology, and end-stage organ failure. With limited life expectancy and the presence of comorbidities, diabetes management can be challenging. While there is little clinical evidence to guide decision-makers, current practice depends on empiric and expert recommendations. Objective: To evaluate the current prescribing patterns and monitoring parameters in diabetes management at the EoL in patients at two palliative care inpatient units. Design: Retrospective clinical chart review. Setting/subjects: Adult patients attending the Palliative and Supportive Care Services at St Vincent's Private Hospital and Mater Adults Hospital, South Brisbane, Australia over a 24-month period, from October 2014 to October 2016. Results: A total of 145 charts were analysed. 139 patients were identified as having received glucose-lowering therapy (51% female, median age 71 years). Insulin therapy was used in 74 (51%) patients and oral and/or non-insulin therapies in 62 (43%). Blood glucose level monitoring was carried out a median of 4 times, range 1–6 times daily. Either continuously or at some stage of their treatment, 74 patients were receiving corticosteroids. Conclusion: Insulin therapy appears to be the safest and most effective approach, taking into consideration the patient needs and pharmacodynamic profile of each preparation. Without evidence-based guidelines on the optimal intervention to control diabetes at the EoL, therapy plans must be individualized to prevent symptomatic hyper- and hypoglycaemia with minimal patient discomfort and adverse drug reactions.