Top Ten Tips Palliative Care Clinicians Should Know About Managing Diabetes at End-of-Life.

Palliative care clinicians will regularly take care of patients with diabetes and play numerous roles in educating not only patients but also families and care partners regarding the changing balance of harms and benefits of blood glucose control as patients near end of life (EOL). There is limited evidence regarding the optimal timing and process for de-escalation of blood sugar monitoring and diabetes medications (including insulin) in the hospice and EOL setting. Rather, decisions are guided by prognosis, impacts of hypo- or hyperglycemia on a particular patient's symptoms, and the burdens of specific diabetes medications or interventions. Shared decision-making with patients and care partners is essential, as is addressing the emotional impact of changes to diabetes routines, which some patients have adhered to for many years. Diabetes also impacts overall symptom control at EOL. These ten tips guide palliative care clinicians to identify and address the impact of glycemic control, diabetes medications, and common long-term complications of diabetes on symptom burden.