Excessive Rate of Hypoglycemia in Hospice Patients

Information sourced from NEJM Journal Watch:

More than one third of patients treated with insulin experienced hypoglycemia.

A retrospective cohort study, conducted in the U.S. Veterans Affairs (VA) nursing home system between 2006 and 2015, provides evidence that hospice patients often experience hypoglycemia (blood glucose level, <70 mg/dL) and severe hypoglycemia (blood glucose level, <50 mg/dL). A total of 20,329 patients (age, ≥65) with type 2 diabetes were identified at admission to VA nursing homes for hospice care; 1687 of these patients (8%) were receiving insulin. Nearly all patients had died within 100 days.

Cumulative risks for hypoglycemia were 12% among all patients and 38% in those receiving insulin. Corresponding risks for severe hypoglycemia were 5% and 18%.

COMMENT

These results document excessively tight control of blood glucose in a cohort of older diabetic hospice patients with short life expectancies, despite guidelines and expert recommendations to relax glycemic control in such patients (NEJM JW Gen Med Mar 15 2016 and Diabetes Care 2016; 39:308). Because symptoms of severe hypoglycemia can interrupt comfort care near the end of life, insulin therapy generally should be avoided in this population, unless it’s necessary to prevent substantially symptomatic hyperglycemia.

Thomas L. Schwenk, MD reviewing Petrillo LA et al. JAMA Intern Med 2017 Dec 26

CITATION(S):

Petrillo LA et al. Hypoglycemia in hospice patients with type 2 diabetes in a national sample of nursing homes. JAMA Intern Med 2017 Dec 26; [e-pub].

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