Improving Diabetes Care for Hospice Patients

Am J Hosp Palliat Care. 2016 Jul;33(6):517-9. doi: 10.1177/1049909115578386. Epub 2015 Apr 7.

Abstract

Although type 2 diabetes guidelines recommend less aggressive glycemic control for patients with limited life expectancy, many hospice patients continue their glucose-lowering medications, resulting in an increased risk of hypoglycemia. Three common reasons for overly tight glycemic control in hospice patients include (1) discussions about reducing or stopping chronic medications are uncomfortable; (2) many patients and families believe that mild hyperglycemia can cause symptoms; and (3) until 2014, Healthcare Information and Data Information Set (HEDIS) quality indicators for glycemic control included hospice patients. To address these issues, we recommend (1) providers discuss with patients and families upon hospice enrollment that diabetes medications can be reduced or discontinued as their life-limiting disease progresses; (2) keeping blood glucose levels between 200 and 300 mg/dL; and (3) educate providers that HEDIS measures now exclude hospice patients. Implementing these recommendations should decrease the risk of hypoglycemia in hospice patients and improve their quality of life.

Keywords: diabetes mellitus; glucose lowering medication; glycemic control; hospice; hyperglycemia; hypoglycemia.

MeSH terms

  • Blood Glucose
  • Communication
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Hospice Care / organization & administration*
  • Hospice Care / standards
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects
  • Hypoglycemic Agents / therapeutic use*
  • Quality Indicators, Health Care
  • Quality of Life

Substances

  • Blood Glucose
  • Hypoglycemic Agents