Endocrine Abstracts

At end of life, the focus of Diabetes management shifts from the prevention of long-term complications to ensuring that the symptoms of hypo/hyperglycaemia are minimised. We audited the management of diabetes in End-of-Life Care (EOLC), against Diabetes UK “End of Life Guidance for Diabetes Care” to identify strengths and weaknesses of current practice. We identified patients with diabetes who had a “Do not attempt resuscitation-comfort focused care” (DNAR-CFC) order” and died between June 2024-January 2025, excluding Emergency Department and Intensive Care Unit Deaths. We recorded demographics, medication, BGL data, palliative care and endocrine team input. n = 36 patients met inclusion criteria. 1 patient had Type 1 DM, with basal/bolus regimen and multiple BGL checks continued inappropriately on transition to DNAR-CFC. 35/36 had T2DM. 5/35 were on Metformin monotherapy, which was ceased appropriately in all on transition to DNAR-CFC. 30 were on Oral Hypoglycaemic Agents (OHAs), glucagon-like-peptide-1-agonists (GLP-1s), Insulin or a combination. OHAs/GLP1s were ceased in 17/17 patients on transition to comfort care as per guidelines. Insulin was ceased in 21/22 patients (95.45%) and only 3 had further BGL checks despite guidelines recommending at least once daily measurement. Palliative care were consulted in 29 (82.86%) and Endocrine were consulted in 6 (17.14%) in the last days of life. There was varying practice of diabetes management at end of life with infrequent measuring of BSL post insulin cessation. Development of a St. James’s Hospital specific Guideline and education of nursing and medical staff is required to improve management of DM in EOLC.