Diabetics may often fare poorly in hospice care

January 4, 2018 by Serena Gordon, Healthday Reporter

(HealthDay)—Decisions about diabetes care can become harder as people age, and that may be especially true for those needing hospice care.

A new study has found that, among people getting in a nursing home, may lead to higher rates of dangerous low episodes, known as hypoglycemia.

That finding came from the researchers' analysis of data on nearly 20,000 people with type 2 diabetes, all in and receiving hospice care.

In 180 days, the time period covered by the study, about one in nine people experienced low blood sugar episodes. But, among those treated with insulin, about one in three had low blood sugar episodes, according to the study's lead author, Dr. Laura Petrillo, an instructor in medicine at Harvard Medical School.

Low blood sugar can cause weakness, sweating, confusion, shakiness and dizziness, which can cause suffering and reduced quality of life. The researchers defined low blood sugar episodes as under 70 milligrams per deciliter (mg/dL).

"Hospice is care focused on maximizing comfort at the end-of-life, and usually includes stopping treatments that are unlikely to have short-term benefits," Petrillo said. "Patients with type 2 diabetes were experiencing hypoglycemia, which would be an indication that there was room for improvement in their diabetes care."

The study also looked at high blood sugar episodes, defined as blood sugar levels over 400 mg/dL. High blood sugar—hyperglycemia—can cause excessive thirst and a need to urinate more frequently. During the 180 days, 38 percent of patients treated with insulin had low blood sugar, 18 percent had severe low blood sugar and 35 percent had .

Blood sugar levels were checked an average of 1.7 times a day for people on insulin and 0.6 times a day for those who weren't given insulin, according to the report.

People in the study were receiving end-of-life care at Veterans Affairs nursing homes between 2006 and 2015. All were 65 or older, and nearly all—98 percent—were men. About 83 percent died before 100 days.

The study findings bring up an important issue—the need for more specific guidelines for diabetes management in nursing home and hospice patients, according to Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City.

Those institutions often "export guidelines for hospitalized patients, and end up continuing to use a lot of medications that cause hypoglycemia," he said.

Zonszein noted that insulin isn't the only medication that can cause low blood sugar levels. Some oral diabetes medications also can cause blood sugar levels to drop too low.

In addition to causing people to feel terrible, levels can also increase the likelihood of falls—a concern in hospice facilities and in nursing homes, he explained.

"If medications are not improving quality of life in hospice, it doesn't make sense to use them," Zonszein said. "There are many newer medications that don't cause lows and control the highs. They cost more, but you don't have to monitor patients as much," so ultimately they're likely cost-saving, he suggested.

Matt Petersen, managing director of medical information for the American Diabetes Association, said that the study adds to the understanding of end-of-life care for people with .

"Hypoglycemia is to be avoided for safety and quality of life, but severe hyperglycemia is also to be avoided for the same reasons—left to go too high, glucose levels can lead to catastrophic (and very unpleasant) metabolic crisis," Petersen said. "In patients that may not be eating well, estimating insulin dosing to match food intake can be challenging."

Petersen said it appears from the information provided that patients in the study were receiving individualized care based on their health condition, which is what the American Diabetes Association recommends for care.

"Care should involve a comprehensive consideration of what will ensure the best circumstances for the patient," he noted.

The study authors pointed out that about one-quarter of people in the United States die in a nursing home, making this a problem many people might face.

What, then, can people do to ensure they or a loved one receives the right care for them in a nursing home, particularly as they near the end-of-life?

"Advocate for your loved ones," Petrillo advised. "Ask for a medication review, and make sure that medications are geared toward providing comfort and that they're not receiving anything that doesn't have a short-term benefit."

The study was published as a research letter in the Dec. 26 online edition of JAMA Internal Medicine.

Explore further: Exercising safely with diabetes

More information: Laura Petrillo, M.D., instructor in medicine, Harvard Medical School, Boston; Matt Petersen, managing director of medical information, American Diabetes Association; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, New York City; Dec. 26, 2017, JAMA Internal Medicine, online

The American Hospice Foundation has more on hospice in nursing homes.

Related Stories

Exercising safely with diabetes

July 7, 2017
(HealthDay)—Exercise is a powerful tool for managing diabetes.

Low blood glucose levels in hospitalized patients linked to increased mortality risk

November 17, 2016
In hospitalized patients, low blood sugar—also known as hypoglycemia—is associated with increased short- and long-term mortality risk, according to a new study published in the Endocrine Society's Journal of Clinical ...

Artificial pancreas improves blood sugar control in young kids

April 3, 2017
An artificial pancreas, which delivers insulin in an automated way to individuals with type 1 diabetes, appears to be safe and effective for use in children ages 5 to 8 years, a new study finds. Results will be presented ...

New tool identifies diabetes patients at risk for low blood sugar emergencies

August 21, 2017
A team led by Kaiser Permanente researchers has developed and validated a practical tool for identifying diabetes patients who are at the highest risk for being admitted to an emergency department or hospital due to severe ...

Is the finger-stick blood test necessary for type 2 diabetes treatment?

June 10, 2017
In a landmark study, UNC School of Medicine researchers have shown that blood glucose testing does not offer a significant advantage in blood sugar control or quality of life for type 2 diabetes patients who are not treated ...

Suicide by insulin?

May 19, 2017
(HealthDay)—Insulin typically saves the lives of those with diabetes, but it can also be a way for some people to kill themselves, a new review warns.

Recommended for you

Genetic discovery may help better identify children at risk for type 1 diabetes

January 17, 2018
Six novel chromosomal regions identified by scientists leading a large, prospective study of children at risk for type 1 diabetes will enable the discovery of more genes that cause the disease and more targets for treating ...

Thirty-year study shows women who breastfeed for six months or more reduce their diabetes risk

January 16, 2018
In a long-term national study, breastfeeding for six months or longer cuts the risk of developing type 2 diabetes nearly in half for women throughout their childbearing years, according to new Kaiser Permanente research published ...

Women who have gestational diabetes in pregnancy are at higher risk of future health issues

January 16, 2018
Women who have gestational diabetes mellitus (GDM) during pregnancy have a higher than usual risk of developing type 2 diabetes, hypertension, and ischemic heart disease in the future, according to new research led by the ...

Diabetes gene found that causes low and high blood sugar levels in the same family

January 15, 2018
A study of families with rare blood sugar conditions has revealed a new gene thought to be critical in the regulation of insulin, the key hormone in diabetes.

Discovery could lead to new therapies for diabetics

January 12, 2018
New research by MDI Biological Laboratory scientist Sandra Rieger, Ph.D., and her team has demonstrated that an enzyme she had previously identified as playing a role in peripheral neuropathy induced by cancer chemotherapy ...

Enzyme shown to regulate inflammation and metabolism in fat tissue

January 11, 2018
The human body has two primary kinds of fat—white fat, which stores excess calories and is associated with obesity, and brown fat, which burns calories in order to produce heat and has garnered interest as a potential means ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.