Audit on the management of diabetes in terminally-ill medical patients

Introduction: The management of diabetes in terminally-ill patients poses a dilemma with huge variations in practice in the hospital setting. The aim of this study was to establish how diabetes is currently managed in terminally-ill patients admitted to medical wards. Methods: Retrospective case note analysis of details of diabetes monitoring and management, changes in diabetes monitoring and managing once the patient was recognized to be terminally-ill, and how close to death did these changes (if any) occurred in 25 terminally-ill diabetic patients in a university teaching hospital. Results: 14 out of 25 patients had their diabetes monitoring discontinued before they died, and a further three patients had their monitoring reduced in frequency. For eight of these 17 patients, these changes were made only within 24 h of death. Fourteen out of 16 diabetic patients had their diabetes medication discontinued. One patient had oral hypoglycaemic medication discontinued but regular insulin injection continued. For four of these 15 patients, the changes were made only within 24 h of death. In only five out of 25 cases was there documentary evidence that a discussion had been made with the patient or their relatives regarding the decision to discontinue active management of diabetes. Conclusions: The management of diabetes was variable with no clear consensus. This remains a challenging area and without evidence-based guidelines to aid clinical decisions, healthcare professionals need to consider each patient individually, taking into account the patients' and their families' views when deciding on the appropriate management plan.