It is anticipated that deaths from diabetes will increase by two thirds between 2008 and 2030, which would position diabetes as the seventh leading cause of death in the world by 2030. As well as being the cause of death in a large number of cases, diabetes may provide further complications for patients suffering from other life-limiting illnesses as they near the end of their lives.
The Association of British Clinical Diabetologists (ABCD) states that the combination of ageing populations and rising numbers of people with diabetes means that “more individuals will be reaching the end of their life with co-existent diabetes”. To enhance the care and experience of those dying with diabetes, along with that of their carers and families, the ABCD highlights the importance of good coordination and collaboration between diabetes multidisciplinary care teams and end of life care services. Issues around glycaemic control at the end of life are also highlighted and there is recognition of the support that an experienced dietician can offer for those with poor food intake.
Dr Vincent Vandenhaute of Europe Hospitals in Belgium called for new guidelines for providing palliative care to patients with Type II diabetes. Dr Vanderhaut said that previously published standardized recommendations for the management and treatment of Type II diabetes “go against the quality of life goals promoted by hospice and palliative care” when applied to an end-of-life population and that “when faced with diabetes, caregivers tend to overmedicate.”
The end of life diabetes care strategy published by Diabetes UK (2012) reminds us of the ‘unique set’ of health and social care needs for patients with diabetes at the end of life and notes that ‘Patients dying with diabetes may have an increased frequency of symptoms such as pain, constipation and fatigue’. However, there is a lack of existing international clinical guidelines or quality standards in the area. The authors of the strategy aim to describe a consistent high quality approach to end of life care for people with diabetes by providing a series of clinical care recommendations.
A recent informal literature review revealed that the vast majority of research into diabetes and palliative care had been conducted in the United Kingdom and the United States, with very little scientific research conducted on this subject in the developing world.
The Diabetes Programme of the World Health Organization has committed to “improve health through stimulating and supporting the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low- and middle-income countries.”
Perspectives on palliative care and diabetes from around the world are publicised today on the different editions of ehospice. On the Africa edition there is a video showing the struggle of a young African man as he deals with his symptoms. The India edition includes an article written by an expert in the field. The Australia edition features an article on diabetes and palliative care from an Australian perspective. The UK edition reviews the literature on the subject and calls for more awareness of this critical issue.