title: Glycaemic control in end-of-life care.
abstract: OBJECTIVE
  Diabetes mellitus is one of the most common comorbidities in palliative care. Yet, the optimal handling of diabetes mellitus in dying patients is debated. This review aims to discuss comprehensively the scientific basis as of today for diabetes mellitus management decisions in end-of-life (EOL) care.
  
  
  RESULTS
  Glycaemic control provides prognostic information in EOL care of diabetes mellitus patients. Original data on how to manage dying patients with type 2 diabetes mellitus are scarce. Findings in elderly type 2 diabetes mellitus patients and expert opinions support that glycaemic control should be relaxed in dying patients with type 2 diabetes mellitus, in the absence of risk factors for true insulin dependence, to avoid symptomatic hypoglycaemia.For terminal but conscious type 1 diabetes mellitus patients, regular blood glucose measurements and continued insulin therapy is the mainstay, with some discrepancy in preferred management between palliative care physicians and diabetes consultants. No randomized controlled trials are available.Improvement is clearly needed with regard to communication about diabetes mellitus in EOL and documentation of decisions.Corticosteroid-induced diabetes mellitus is a significant problem in palliative care, but predictors exist.
  
  
  CONCLUSIONS
  In the absence of large observational studies or randomized controlled trials, the current body of knowledge is based on expert opinions, surveys and retrospective studies. Nevertheless, some clinically meaningful recommendations can be made. Prospective studies need to be performed in order to improve our understanding about diabetes mellitus management in EOL. The palliative care community has a joint responsibility to address these questions.
authors.affiliation: aDepartment of Radiology, Oncology and Radiation Science, Unit of Oncology, Uppsala University, Uppsala bDepartment of Oncology and Pathology cDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Solna dPalliativt utvecklingscentrum, Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Lindskog
authors.forename: Lars
authors.initials: L
authors.lastname: Kärvestedt
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Fürst
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000368:Aged; D001786:Blood Glucose; D003142:Communication; D003920:Diabetes Mellitus / Q000139:chemically induced; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D010166:Palliative Care; D013727:Terminal Care
chemical_list: D000305:Adrenal Cortex Hormones; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin