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

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 facilitate 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.