Ending Diabetes Treatment for Hospice Patients May Improve Quality of Life

Older adults who suffer from a life-limiting illness or advanced dementia may benefit from cessation of diabetes treatment as they near their final days, new research has found. 

Prior research on appropriate levels of diabetes is scarce, according to the study’s authors. But their conclusions suggest that continuing diabetes treatment at the end of life could present fall risks, loss of consciousness or adverse drug events. The research was published in the Journal of the American Geriatrics Society.

“For older adults who have a limited life expectancy or who have advanced dementia, however, maintaining that target blood sugar level may cause more harm than good. For example, these older adults may not live long enough to experience potential benefits,” the authors indicated. “What’s more, maintaining these strict blood sugar levels can raise the risk of potentially harmful events such as low blood sugar (also known as hypoglycemia).”

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Nearly 25% of people in the United States age 65 or older has been diagnosed with diabetes, according to the American Geriatrics Society. The disease is the seventh-leading cause of death in the United States and is a significant contributor to the prevalence of heart disease. While maintaining target blood sugar levels is essential to the treatment of patients who have not yet reached the end of life, the opposite may be true for those who are close to death.

Some guidelines for diabetes treatment for older adults suggest that higher blood sugar targets, between 8% and 9% may be advisable, especially for those with multiple chronic conditions or who are residents of nursing homes, according to the study. 

The researchers examined potential overtreatment and deintensification for diabetes among seriously ill Department of Veterans’ Affairs (VA) nursing home residents as well as patients with dementia. They looked for signs of overtreatment for diabetes, whether patients had reduced their medications for that condition as well as the impact of lower doses or transitions to different medications.

In those institutions, the study authors identified potential overtreatment of diabetes in close to 44% of nursing home admissions involving patients that met their criteria between 2009 and 2015. Most of these patients were close to 78-years-old and nearly all were white males, and nearly 30% suffered from advanced dementia. About 79% had a moderately high risk of dying within six months.

Results indicated that reducing diabetes treatments near the end of life may reduce unnecessary hospitalizations, which is a significant goal for may hospice providers as the majority of patients indicate they would choose to die at home. 

“Deintensifying diabetes treatment regimens in patients with [life-limiting illness/advanced dementia] has the potential to prevent unnecessary hospitalizations due to adverse drug events, reduce medication burden, and increase comfort,” the authors wrote. “Future studies should examine the impact of deintensification on health outcomes and adverse events to better understand the risks and benefits of diabetes management strategies in this population.”