Diabetes and Palliative Care: A Framework to Help Clinicians Proactively Plan for Personalized care

Abstract

The aim of the chapter is to provide a brief overview of diabetes and the associated morbidities that affect life expectancy to highlight why proactively planning for palliative and end-of-life care is essential to quality personalized diabetes care. Life expectancy may not be significantly reduced if blood glucose, lipids and blood pressure are well controlled; but several diabetes-related complications and long duration of diabetes affect life expectancy. Significantly, complications and related organ and tissue damage can be present 10–15 years before type 2 diabetes is diagnosed. The challenge of prognostication is discussed as recommendations for when to consider changing the focus of care from preventing diabetes complications to palliation and comfort care. Life-limiting illness and palliative and end-of-life care are defined. A framework for integrating diabetes and palliative care is proposed. The framework could help clinicians and people with diabetes prevent/manage complications and plan care to maintain quality of life, dignity and autonomy and ameliorate suffering as their life trajectory changes. The framework aims to facili-tate care transitions and help clinicians proactively initiate management and have timely meaningful conversations about palliative and end-of-life care with older people with diabetes and their families.