Skip to main content
  • Health Care Delivery Systems and Implementation in Diabetes (EB Morton-Eggleston and ME McDonnell, Section Editors)
  • Published:

Caring for People with Diabetes at the End of Life


End-of-life care planning is assuming global significance. While general end-of-life care guidelines apply to diabetes, there are some diabetes-specific issues that need to be considered. These include the usual long trajectory to end-of-life care that enables clinicians and people with diabetes to proactively discuss when to change the focus of care from preventing diabetes complications (tight control) to a palliative approach. Palliative care aims to promote comfort and quality of life and reduce the unnecessary burden of care on individuals and their families. The aim of this paper is to discuss common disease trajectories and their relationship to diabetes care, outline strategies for proactively discussing these issues and suggest indications that palliative care is warranted.

This is a preview of subscription content, access via your institution.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. International Diabetes Federation (IDF). Global guideline for managing older people with type 2 diabetes. Brussels: IDF; 2013.

    Google Scholar 

  2. Mc Ewen L. More death certificates cite diabetes as underlying cause of death. Diabetes Care. 2011;34:1529–33.

    Article  Google Scholar 

  3. IDF. IDF diabetes atlas. 7th ed. Brussels: IDF; 2015.

    Google Scholar 

  4. National Health and Medical Research Council (NHMRC). An ethical framework for integrating palliative care principles into the management of advanced chronic or terminal conditions, National Health and Medical Research Council, 2011. Discusses some of the ethical issues involved when implementing palliative care for people with severe and terminal chronic diseases.

  5. Worldwide Palliative Care Alliance (WPCA)/World health Organisation (WHO). 2014.

  6. Sinclair A, Gadsby R, Penfold S, Croxon S, Bayer A. Prevalence of diabetes in care home residents. Diabetes Care. 2001;24(6):1066–58.

    CAS  Article  PubMed  Google Scholar 

  7. Lynn J, Adamson D, Rand Corporation. Living well at the end of life adapting health care to serious chronic illness in old age. Santa Monica: RAND, CA; 2003. Accessed March 2016. Discusses general disease trajectories.

  8. Agency for Healthcare Research and Quality. 2014. Accessed Feb 2016.

  9. Buckley T, Sunari D, Marshall A, et al. Physiological correlates of bereavement and the impact of bereavement interventions. Dialogues Clin Neurosci. 2012;14(92):129–39.

    PubMed  PubMed Central  Google Scholar 

  10. Shammas M. Telomeres, lifestyle, cancer and aging. Curr Opin Clin Nutr Metab Care. 2011;14(1):26–34.

    Article  Google Scholar 

  11. Weissman D. Decision making at a time of crisis near the end of life. J Am Med Assoc. 2016;282(14):1738–43.

    Google Scholar 

  12. Bailey A, Harman S, Bruera E, Arnold R, Savarese D. Palliative care; the last hours and days of life, 2016. Wolters Kluwer UpToDate Accessed June 2016. Comprehensive discussion about terminal care with a paragraph about diabetes in the terminal stage.

  13. Clegg A, Bates C, Young J, et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016;45:353–60.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hogan D, MacKnight C, Bergman H. Models, definitions and criteria of frailty. Aging Clin Exp Res. 2003;15 Suppl 1:1–29.

    PubMed  Google Scholar 

  15. Rockwood K, Song X, Bergman H, Hogan D, McDowell I, Mintski A. A global clinical measure of fitness and frailty in elderly people. CAMJ. 2006;17(3):489–96.

    Google Scholar 

  16. Stirling C, McInerney F, Andrews S, et al. A tool kit to aid talking about dementia and dying—development and evaluation. Collegian. 2013;21:337–43.

    Article  Google Scholar 

  17. National Health Service (NHS) England (2015) Personalised care and support planning handbook. Accessed Feb 2016.

  18. Leadership Alliance for the Care of Dying People. One chance to get it right. London: LACDP; 2014.

    Google Scholar 

  19. Emanuel L, Alexander C, Arnold R, et al. Integrating palliative care into disease management guidelines. J Palliat Med. 2004;7:74–83.

    Article  Google Scholar 

  20. Worldwide Palliative Care Alliance and World Health Organisation. Global atlas of palliative care at the end of life, 2014 Accessed March 2016. Leading proponent of palliative care with important care information and strategies.

  21. Dunning T. Integrating palliative care with usual care of diabetic foot wounds. Diabetes Metab Res Rev. 2016. doi:10.1002/dmrr.2758. Suggest some strategies for combining usual diabetes foot care with a palliative approach to care.

    PubMed  Google Scholar 

  22. Gold Standards Framework Centre 2011. Prognostic indicator guidance, 2011. Discusses some prognostic indicators that the individual with chronic disease is deteriorating but does not include diabetes.

  23. Munshi M, Hermes F, Huang E, et al. Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(2):308–18. doi:10.2337/dc15-2512.

    Article  PubMed  Google Scholar 

  24. Rowles S, Kilvert A, Sinclair A, on behalf of the Association of British Clinical Diabetologists. ABCD position statement on diabetes and end of life care. Pract Diabetes Int. 2011;28(1):26–7.

    Article  Google Scholar 

  25. Dunning T, Martin P, Savage S, Duggan N. Guidelines for managing diabetes at the end of life, 2010. Innovative first guideline to describe diabetes management at the end of life.

  26. Ganna IE. 5-year mortality predictors in 498,103 participants: a prospective population-based study. Lancet. 2015;386(9993):533–40. doi:10.1016/S0140-6736(15)60175-1.

    Article  PubMed  Google Scholar 

  27. UK Biobank Longevity Explorer Accessed June 2016.

  28. Reymond L. End of life care: proactive clinical management of older Australians. Aust Fam Physician. 2016;45(1–2):76–8.

    PubMed  Google Scholar 

  29. National Prescribing Service Ltd/Palliative Care Australia. Achieving quality use of medicines in the community for palliative and end of life care: a consultation report. Sydney: National Prescribing Service; 2009.

    Google Scholar 

  30. Cox-North P, Doorenbo A, Shannon S, Scott J, Curtis J. The transition to end-of-life care in end-stage liver disease. J Hosp Palliat Nurs. 2013;15(4):209–15.

    Article  Google Scholar 

  31. Claessen S, Francke A, Engels Y, Deliens L. How do GPs identify a need for palliative care in their patients? An interview study. BMC Family Pract. 2013;14:42.

    Article  Google Scholar 

  32. Sommerfield A, Deary I, Frie B. Acute hyperglycemia alters mood state and impairs cognitive performance in people with type 2 diabetes. Diabetes Care. 2004;27(10):2335–40.

    Article  PubMed  Google Scholar 

  33. Feinkohl I, Keller P, Aung M, et al. Severe hypoglycemia and cognitive decline in older people with type 2 diabetes: the Edinburgh type 2 diabetes study. Diabetes Care. 2014;37(2):507–15.

    CAS  Article  PubMed  Google Scholar 

  34. Swerissen H, Duckett S. Dying Well. Grattan Institute, 2014. ISBN: 1-925015-61-4.

  35. Quinn K, Hudson P, Dunning T. Diabetes management in patients receiving palliative care. J Pain Symptom Manag. 2006;32(3):275–86.

    Article  Google Scholar 

  36. Savage S, Duggan N, Dunning T, Martin P. The experiences and care preferences of people with diabetes at the end of life: a qualitative study. J Hosp Palliat Nurs. 2012;14(4):293–302. doi:10.1097/NJH.0b013e31824bdb39.

    Article  Google Scholar 

  37. Temel J. When more is not better: how to integrate goals of care in conversations about stopping chemotherapy. Program and Abstracts of the 2015 American Society of Clinical Oncology Annual Meeting, May 29 June, Chicago, Illinois, 2015.

  38. Holloway K, Toye C, McConlgley R, Tieman J, Currow D, Hegarty M. National consultation informing development of guidelines for a palliative approach for aged care community settings. Aus J Ageing. 2012;34(1):21–6.

    Article  Google Scholar 

  39. Majesko A. Palliative care: more than a natural talent and good communication. Society of Critical Care Medicine, 2012…/Palliative-Care---More-Than-Natural-Talent-and-Good-Communication.aspx. Accessed June 2016.

  40. Diabetes UK, End of life diabetes care. A strategy document, Diabetes UK, 2012. One of the first publications to address diabetes and end of life care.

  41. Advisory Board Company. Realising the full benefit of palliative care advisory, Accessed Feb 2016. Suggests useful information to guide conversations and decisions about palliative care.

  42. The Strengthening Palliative Care: Policy and Strategic Directions 2012–2022. Victorian Health Priorities Framework 2012–2022: Metropolitan Health Plan. Victorian Government 2014. Advance Care Planning http// Accessed Dec 2015.

  43. Care search smart phone apps, Accessed May 2016.

  44. Death Over Dinner. Accessed June 2016.

  45. Payne T. The Ancient art of growing old. London: Vintage Classics, Random House; 2013.

    Google Scholar 

  46. Palliative Care Outcomes Collaboration (PCOC). PCOC clinical manual, 2014,

  47. Lamont E, Chrisakis N. Prognostication in advanced disease. In: Berger A, Portenoy H, Weissman D, editors. Principles and practice of palliative care and supportive oncology. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 607–14.

    Google Scholar 

  48. Roter D, Hall A, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. J Am Med Assoc. 2002;288:756–64.

    Article  Google Scholar 

  49. Karppinen H, Laakkonen M-L, Strandberg T, Tivis R, Pikaia K. Will-to-live and survival in 10-year follow-up among older people. Age Ageing. 2012;41(6):789–94.

    Article  PubMed  Google Scholar 

  50. Cardoso-Cruz H, Lima D, Galhardo V. Impaired spatial memory performance in a rat model of neuropathic pain is associated with reduced hippocampal-prefrontal cortex connectivity. J Neurosci. 2012;33(6):2465–80.

    Article  Google Scholar 

  51. Shi Q, Liu S, Fonseca V, Shi L. The effect of metformin exposure on neurodegenerative disease among elder adult veterans with diabetes mellitus, American Diabetes Association 2016 scientific sessions, June 11, 2016, New Orleans, Louisiana, 2016. Abstract 72-OR/72. Accessed June 2016.

  52. Chua W-L, Liaw S-L. Assessing beyond vital signs to detect early patient deterioration. Evid Based Nurs. 2016;19(2):53.

    Article  PubMed  Google Scholar 

  53. Stewart F, Goddard C, Schiff R, Hall S. Advanced Care planning in care homes for older people: a qualitative study of the views of care staff and families. Age Ageing. 2011;40:230–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Trisha Dunning.

Ethics declarations

Conflict of Interest

Trisha Dunning, Nicole Duggan and Sally Savage declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Health Care Delivery Systems and Implementation in Diabetes

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dunning, T., Duggan, N. & Savage, S. Caring for People with Diabetes at the End of Life. Curr Diab Rep 16, 103 (2016).

Download citation

  • Published:

  • DOI:


  • Diabetes
  • Trajectories
  • Palliative
  • End of life
  • Terminal
  • Advance care panning