Introduction Diabetes is an increasingly common co-morbidity and Diabetes UK has provided guidelines to help decision-making during patients‘ last days of life to maximise symptom control.
Method Standards were created based upon Diabetes UK guidelines and were approved by the North West Audit Group. An online data collection tool was created and distributed regionally.
Results There were 135 responses from 6 hospitals and 7 hospices with 88% of patients aged over 60, 56% female and 94% had type 2 diabetes. On recognition of dying, 41% patients had a plan communicated with them, however, compliance increased if insulin was prescribed or having type 1 diabetes. For those on insulin, only 47% involved a management discussion with diabetes specialists (54% hospital, 33% hospice). In type 2 diabetes controlled by diet or metformin alone, 85% had medication and monitoring stopped. In patients with type 2 diabetes who continued insulin in last days of life, 57% were prescribed once daily insulin (46% hospital, 75% hospice) and 57% had an appropriate initial dose adjustment (50% hospital, 67% hospice). Daily capillary blood glucose (CBG) occurred in 96% patients and when not within satisfactory ranges 75% patients had an appropriate insulin dose adjustment. In the last days of life for patients with type 1 diabetes 50% were prescribed a once daily insulin regime with 100% having initial appropriate dose adjustments. Only 62.5% had a daily CBG (80% hospital, 33% hospice).
Discussion In hospitals there was increased diabetes specialist involvement and management of type 1 diabetics adhered closer to guidelines, suggesting availability of services being beneficial. Hospices were more likely to communicate plans effectively. Insulin use and monitoring of CBG varied, possibly demonstrating lack of knowledge or familiarity with guidelines. Recommendations include improvements in education (especially insulin use) and establishing formal links between palliative care and diabetic services.
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