Sugar & Serenity: End-of-Life Diabetes Care-HMDCB Diabetes Webinar

Video Transcription

Video Summary

This comprehensive discussion highlights the nuanced management of diabetes in hospice care, emphasizing comfort over disease control. Most hospice patients with diabetes have it as a comorbidity rather than a primary diagnosis, shifting focus from long-term glycemic targets to symptom relief and quality of life. Traditional tight glucose control gives way to gentler monitoring, simplified medication regimens, and strategic deprescribing—especially of drugs like statins, antihypertensives, aspirin, and various diabetic medications (metformin, sulfonylureas, TZDs, GLP-1 agonists, and SGLT-2 inhibitors)—to reduce side effects and pill burden. Insulin remains essential, particularly for type 1 diabetes, but dosing is simplified to avoid hypoglycemia and ketoacidosis.<br /><br />End-of-life care also addresses complexities like medication-induced glucose fluctuations, infection management focused on comfort rather than eradication, and attention to pain and mental health. Falls, hyponatremia, and depression require sensitive, individualized interventions. The approach advocates for shared decision-making, family education, and attentiveness to the patient’s evolving goals.<br /><br />Ultimately, the message is that end-of-life diabetes care is not about strict control but about compassionate, tailored management that honors dignity and prioritizes comfort, supported by tools like the upcoming HOPE framework to enhance patient-centered planning and communication.

Keywords

diabetes management

hospice care

comfort-focused treatment

glycemic control

medication deprescribing

insulin therapy

end-of-life care

patient-centered planning