Background Diabetes is becoming increasingly common. New onset diabetes can occur due to steroid therapy or malignancy. The management of diabetes in palliative and end of life care tends to be very variable and idiosyncratic.
Aims To develop guidelines to provide a practical, coordinated approach to managing diabetes in palliative patients across primary and secondary care.
Methods A literature search was conducted to determine the guidelines available for the management of diabetes in palliative patients. A team of doctors including a diabetes and palliative medicine consultant, GP and hospice practitioner held a series of meetings to discuss and produce comprehensive guidance for the management of diabetes from the diagnosis of a palliative illness up to and including the last days of life. Draft guidelines were shared with other diabetes consultants and nurses for comment. Feedback was sought from ward, district, hospice and Macmillan nurses.
Results The guidelines explain the change in emphasis of diabetes care in palliative patients, focusing on quality of life rather than the prevention of long term complications. They advise on drug management, but also stress the importance of psychological and family support. Guidance is given on the management of steroid induced diabetes and a flowchart for dying patients was designed to be used alongside the end of life care pathway.
Conclusion The evidence base for comprehensive guideline development is poor so a pragmatic interspeciality collaborative approach working between primary and secondary care was taken to develop guidelines aimed at improving integrated patient care. They are adopted locally and by neighbouring Trusts. The guidelines have been presented throughout the Northern Region and it is hoped that a national approach will be developed in part based on our experience. Research is needed to assess the effect of the guidance on patient care.
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