Control and Treatment of End-of-Life Diabetes Mellitus: Review

Abstract

Introduction: Diabetes mellitus prevalence in palliative patients tends to rise. The therapeutic goal guided strategies commonly used in diabetic patients are inadequate in the context of palliative care. Actually, these strategies may compromise the principles of well-being and quality of life by focusing on the prevention of long-term complications. The issues in this context are numerous. What is the target value of adequate metabolic control? Does HbA1C-based disease control remain acceptable? What drugs should we prefer in these patients? Our purpose is to review up-todate literature concerning the best practices in managing diabetes mellitus on a terminal ill patient.

Methods: At November 2019, we searched review articles, observational studies, guidelines, and opinion articles with the terms “palliative care” and “diabetes mellitus” published in the last 10 years, in English, Spanish and Portuguese, on the databases: Medline / PubMed, National Institute for Health and Care Excellence (NICE) and Scienc- Direct.

Results: When managing diabetes mellitus in a terminally ill patient, it is imperative to keep in mind the ultimate clinical goal for the patient: to prevent acute complications of hypoglycemia or hyperglycemia. Most studies report that HbA1C monitorization has little relevance. Screening for capillary glycemia should be reduced or abolished. If performed, values between 108 and 270 mg / dL should be tolerated if the average life expectancy is months or values between 180- 360 mg/dl if the average life expectancy is weeks or days. To establish an individualized therapeutic plan, the palliative care team should take into account several characteristics of the patient and caregivers. Every change should represent an effort to simplify therapeutic schemes. Pharmacokinetic and pharmacodynamic characteristics of each drug, side effects and potential for hypoglycemia should be considered. Strict avoidance of sugary food is not necessary.