MedicalResearch.com Interview with:
Dr. Laura A. Petrillo MD
Instructor in Medicine
Harvard Medical School, and Palliative Care Physician
Massachusetts General Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hospice is end-of-life care focused on maximizing quality of life. Hospice often involves reducing or stopping treatments that are unlikely to have short-term benefit in order to avoid uncomfortable side effects. About a quarter of Americans die in nursing homes, and some of them receive hospice care in their final days. We looked at whether adults with type 2 diabetes experience low blood sugar while on hospice in veterans’ nursing homes, since low blood sugar signals inappropriately aggressive diabetes treatment in patients close to death and contributes to unnecessary discomfort.
We found that one in nine people experienced low blood sugar at least once while receiving hospice care. Among people who were on insulin, the number was one in three.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Our study indicates that clinicians in nursing homes may not fully transition from standard care to comfort-focused care when adults with type 2 diabetes are enrolled in hospice. Clinicians who care for patients at the end of life should follow the American Diabetes Association guidelines, which recommend relaxing glucose targets as patients with type 2 diabetes near death and eventually discontinuing medications to avoid low blood sugar and reduce burdensome monitoring.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research should investigate the optimal timing and schedule for decreasing and stopping medications for patients with type 2 diabetes on hospice in order to minimize low blood sugar events and invasive monitoring. Researchers should also develop better tools to estimate prognosis in order to guide patients’ and clinicians’ decisions about how to weigh tradeoffs in medical treatment.
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Laura A. Petrillo, Siqi Gan, Bocheng Jing, Sean Lang-Brown, W. John Boscardin, Sei J. Lee. Hypoglycemia in Hospice Patients With Type 2 Diabetes in a National Sample of Nursing Homes. JAMA Intern Med. Published online December 26, 2017. doi:10.1001/jamainternmed.2017.7744
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