Diabetes mellitus (DM) affects >400 million people, corresponding to 8.5% of adults worldwide. The incidence of DM in patients receiving palliative care is higher than in the general population due to several factors, such as age, use of diabetogenic drugs such as corticosteroids and metabolic changes due to chronic disease. This association is intended to grow as a result of the rising burden of DM worldwide, ageing populations and the improved overall survival time of several diseases over the last few decades.
Palliative care services
The diagnosis of DM has already been made in the majority of patients who are refer to palliative care services. Furthermore, DM is, by itself, an increase cause of palliative enrolment in some countries with advance health system integration as it can be consider as a life-threatening illness.
Evidence base practice guidelines for the management of DM have been develop by several scientific associations, which highlight that nutrition, pharmacological therapy, self-monitoring blood glucose and glycated haemoglobin (HbA1c) targets should be individualise for each patient. Additionally, goals be individualize base on the duration of DM, age or life expectancy, comorbid conditions; so know cardiovascular disease or advance microvascular complications, hypoglycaemia unawareness and individual patient considerations.
Although less restrictive glycaemic targets for DM management in the context of palliative care; which are usually suggest, recommendations are mainly base on expert opinion. Indeed, there is a lack of relevant evidence particularly; so from randomise clinical trials that guides DM management in the context of palliative care.
Diabetes Mellitus in people
Even the opinions of diabetologists and oncologists were different dealing with diabetes care in people with cancer. To the best of our knowledge, the most resourceful nutritional approach, oral and injectable (non-insulin) agents; so this types of insulin or insulin regimens, are still unknown to manage DM in the palliative context. Therefore, the DM management in these patients remains a challenge.
Palliative medicine manages the whole person, providing relief from pain, depression; also other distressing symptoms at any stage of the disease and treats joint chronic diseases. As such, the appropriate treatment of hyperglycaemia relate symptoms and DM-relate; so acute complications can contribute to worsening patients’ general condition and QOL; so particularly acute complications; which commonly lead to hospital admissions and additional consequences.
Comfort, patient preferences, evaluation of oral intake and preservation of QOL are of particular importance in palliative medicine and interdisciplinary team care and early referral to relevant clinicians are essential. The systematic review methodology does not require ethics approval due to the nature of the study design. The results of the systematic review will publish in a peer-review journal and will be publicly available. It will also be disseminate electronically and in print versions.