Study: Too Much Hypoglycemia in Diabetic Hospice Patients

https://goo.gl/Quvc9V

When it comes to hospice patients with type 2 diabetes, avoiding hypoglycemia may be more important than strict glycemic control, researchers argued.

In a researcher letter appearing in JAMA Internal Medicine, about 12% of hospice patients with type 2 diabetes residing in nursing home experienced hypoglycemia within 180 days of admission -- a glucose reading under 70 mg/dL.

As for severe hypoglycemia -- a glucose reading under 50 mg/dL -- this was experienced by approximately 5% of hospice patients in nursing homes within 180 days of admission, reported Laura A. Petrillo, MD, of Massachusetts General Hospital in Boston, and colleagues.

The risk was even greater for those receiving insulin: cumulative incidence of 38% for all hypoglycemia and 18% for severe episodes within 180 days of admission, with the peak risk occurring during the initial 20 days. Hyperglycemia incidence was 9% overall; 35% among those on insulin.

"[H]ypoglycemia is not consistent with a goal of comfort, and these data demonstrate suboptimal avoidance of dysglycemia among patients with type 2 diabetes on hospice in nursing homes," wrote Petrillo and colleagues.

According to the 2016 guidelines from the American Diabetes Association, people with diabetes receiving end-of-life care should relax glycemic control targets and eventually discontinue diabetes medication in order to avoid hypoglycemia, which Petrillo's group calls a "potentially preventable cause of suffering among hospice patients."

"Patients treated with insulin lived longer and experienced more hyperglycemia than patients not treated with insulin, which suggests that clinicians may be choosing to continue insulin for those hospice patients with a longer life expectancy and more severe diabetes at hospice admission," the research group noted