Breaking News
May 21, 2018 - FDA Approves Aimovig (erenumab-aooe) as a Preventive Treatment for Migraine
May 21, 2018 - Infant death study reveals dangerous sleep practices among babysitters, relatives, others
May 21, 2018 - Intermittent fasting may increase diabetes risk, shows study
May 21, 2018 - New study shows declines in prostate cancer screening, diagnoses and treatment
May 21, 2018 - Fasting diets could raise risk of diabetes say experts
May 21, 2018 - FDA Alert: 7K and Poseidon 4500 by Shoreside Enterprises: Voluntary Recall
May 21, 2018 - Cell phones at summer camp: Research explores the effects
May 21, 2018 - Birth rate decline driven by waiting longer to have children, cost of infertility treatment
May 21, 2018 - In-hospital opioid prescribing may increase post-discharge opioid use, shows study
May 21, 2018 - ABPI expert urges to find new ‘blockbuster treatments’ for brain tumors
May 21, 2018 - Disruption of Circadian Rhythm Negatively Impacts Mental Health
May 21, 2018 - Researchers reveal mechanisms of periodic paralysis in people with rare genetic disorder
May 21, 2018 - World first use of cognitive training reduces gait freezing in Parkinson’s patients
May 21, 2018 - NIH stops alcohol study that was looking at purported health benefits of drinking
May 21, 2018 - Higher belly fat levels linked to greater risk of vitamin D deficiency
May 21, 2018 - Scientists collate evidence for mismatch between past evolutionary adaptation and modern lives
May 21, 2018 - New case report reveals negative clinical impact of using biotin supplement
May 21, 2018 - Researchers discover new disease mechanism in chronic tobacco smokers
May 21, 2018 - Breast Cancer Patients May Shorten Herceptin Regimen: Study
May 21, 2018 - Bias keeps women with higher body weights away from the doctor: study
May 21, 2018 - Researchers identify protein essential for eye lens development and clear vision
May 21, 2018 - Frontal cortical lesions moderate response to prism adaptation treatment after stroke
May 21, 2018 - Ultrasound guidelines can reliably differentiate between pediatric thyroid nodules that require biopsy
May 21, 2018 - Weight loss is an important predictor of cancer
May 21, 2018 - Ozone exposure at birth linked to increased risk of developing asthma in childhood
May 21, 2018 - CT scan still effective to determine thrombectomy treatment in stroke, study shows
May 21, 2018 - Clot busting drug combo reduces risk of major strokes in high risk patients
May 21, 2018 - New airway transplantation technique shows promising results in lung cancer patients
May 21, 2018 - Biomarker blood test does not appear to curb antibiotic overuse, shows new study
May 21, 2018 - Lilly’s Galcanezumab Meets Primary Endpoint in Phase 3 Study Evaluating Galcanezumab for the Prevention of Episodic Cluster Headache
May 21, 2018 - Grief symptoms similar in donor vs non-donor decision families
May 21, 2018 - Congo to start vaccinating populations against Ebola today to combat outbreak
May 21, 2018 - Researchers use MR spectroscopy to investigate mechanisms behind targeted treatment for gliomas
May 21, 2018 - Study reveals why older workers have higher stress levels than younger colleagues
May 21, 2018 - Health Tip: Taming a Pollen Allergy
May 21, 2018 - Inducing labor at 39 weeks reduces risks of C-section and other complications
May 20, 2018 - Developmental psychotherapy aims at helping antisocial adolescents become responsible adults
May 20, 2018 - People with OCD process emotions differently than their unaffected siblings
May 20, 2018 - Interfering with enzyme’s movement may be new approach for developing of anti-cancer drugs
May 20, 2018 - Prestroke and poststroke oral anticoagulation therapy in AF patients
May 20, 2018 - Why drug users prefer heroin at home, but cocaine while out
May 20, 2018 - Gene therapy that reverses blindness in dogs could also help treat humans
May 20, 2018 - Opioid-Related Payments Linked to Increase in Opioid Rx
May 20, 2018 - Phone apps push people to take their pills
May 20, 2018 - Backbreaking Work May Shorten Men’s Lives
May 20, 2018 - Harsher drug laws won’t stop violence, argues former police chief
May 20, 2018 - Cognitive decline in dementia is not reduced by exercise
May 20, 2018 - Detecting breast cancer with non-invasive ‘disease screening pill’
May 20, 2018 - Simple treatment may minimize hearing loss triggered by loud noises
May 20, 2018 - Alignment of mother and offspring body clock could prevent diseases such as heart disease and obesity
May 20, 2018 - New commercial data warehouse for life sciences
May 20, 2018 - Practice Intervention Targeting IV Opioids May Cut Exposure
May 20, 2018 - New study provides insight into blood signatures of inflammation
May 20, 2018 - Scientists make breakthrough discovery about vitamin B12
May 20, 2018 - What Causes Cancer? Misconceptions Abound
May 20, 2018 - Proper burial of dead cells limits inflammation
May 20, 2018 - Study offers novel solution to suppress metastatic spread of deadly breast cancer
May 20, 2018 - Perspectives of patients and caregivers on care transitions
May 20, 2018 - Guidelines for weight gain in pregnancy should be changed for underweight and very obese women
May 20, 2018 - Researchers transplant retinal sheets derived from human embryonic stem cells in retinal degeneration mouse models
May 20, 2018 - U.S. military personnel at greater risk for skin cancer than general population
May 20, 2018 - Your immune system holds the line against repeat invaders, thanks to this molecule
May 20, 2018 - Between death and deportation
May 20, 2018 - Developing a High Throughput Mass Spectrometry Platform for Drug Discovery
May 19, 2018 - New project aims to increase awareness among hospital clinicians of non-beneficial treatment at end-of-life
May 19, 2018 - Automated bone scan index offers accurate, speedy prognostic information about prostate cancer
May 19, 2018 - Rutgers Cancer Institute nurses research various topics to enhance patient experience
May 19, 2018 - Computer models provide valuable insight to structure and function of Ebola, Zika viruses
May 19, 2018 - Study exposes key tactic used by deadly fungus
May 19, 2018 - Bacterial signals are crucial to development of pre-leukemic myeloproliferation, study shows
May 19, 2018 - Global experts identify key issues in supporting children with brain injuries transition back to school
May 19, 2018 - Social connections may protect black men who have sex with men from acquiring HIV
May 19, 2018 - Study IDs Factors Linked to Quality of Life With Dementia
May 19, 2018 - Potassium — Consumer
May 19, 2018 - HIV-1 viruses transmitted at birth are resistant to antibodies in mother’s blood
May 19, 2018 - Some water pitchers are much better at removing toxins, shows research
May 19, 2018 - Scientists discover how unusually long strands of RNA help colon cancer cells avoid death
May 19, 2018 - International study finds viable treatment option for people with mild asthma
May 19, 2018 - Mayo discovery could enable development of personalized ovarian, brain cancer treatments
May 19, 2018 - ‘Superbug’ Surfaces at Poultry Farm in China
Diabetics may often fare poorly in hospice care

Diabetics may often fare poorly in hospice care

image_pdfDownload PDFimage_print

(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 hospice care in a nursing home, diabetes care may lead to higher rates of dangerous low blood sugar episodes, known as hypoglycemia.

That finding came from the researchers’ analysis of data on nearly 20,000 people with type 2 diabetes, all in nursing homes 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 blood sugar levels 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 high blood sugar.

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, low blood sugar 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 diabetes.

“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.

Journal reference:
JAMA Internal Medicine

Tagged with:

About author

Related Articles