Abstract
Title An exploration of the management of blood glucose in hospital patients with diabetes at the end-of-life. Objective Investigate current practice through retrospective medical notes review and focus group discussion with palliative care, diabetes and generalist specialties to explore their perspectives of end-of-life diabetes care. The aim is to inform service development guidelines to improve the quality of care for patients with diabetes. Design An evaluation research method using a mixed method approach was conducted within an acute care setting. Deceased patient’s records (n=71) were reviewed and data were abstracted for Glycaemic variables, advocacy, diabetes and admission variables to determine the factors influencing admission and end-of-life diabetes management. Descriptive statistics were used to compare the management of cancer and non-cancer patients and referral patterns to palliative care and diabetes specialists. Four focus groups were convened from the individual specialities, and a final mixed specialty group was convened. The participants were predominantly senior medical, nursing, pharmacy and dietician professionals within the hospital. Results The focus group perception of care ideals was not reflected in the medical notes. Capillary Blood Glucose (CBG) is not routinely managed at the end-of-life due to rapid deterioration and death in the majority of patients. Diabetes is apparently treated generically without due consideration to its type or in those patients whose survival goes beyond 72 hours up to 16 days. Patients and relatives views are not routinely sought. The Liverpool Care Pathway (LCP) and limited knowledge for the management of diabetes was found to be a barrier to personalised diabetes care. Conclusion Guidelines have been suggested. Education for practice is required for optimal end-of-life care for patients hospitalised with diabetes.