Palliative Care in Some Chronic Diseases

**109**

**Chapter 9**

**Abstract**

Diabetes and Palliative

Personalized care

people with diabetes and their families.

**1. Introduction**

end of life, diabetes palliative care framework

*Trisha Dunning and Peter Martin*

Care: A Framework to Help

Clinicians Proactively Plan for

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

**Keywords:** diabetes, complications, comorbidity, life-limiting illness, palliative,

Diabetes is the most common chronic disease. People are at risk of diabetes due to genetic inheritance, epigenetic factors, age and lifestyle-related factors. The International Diabetes Federation (IDF) [1] estimated 123 million people aged 65–99 had diagnosed diabetes and predicted the number would increase to 438 million by 2045. Most older people have type 2 diabetes (T2DM), but people with type 1 diabetes (T1D) survive to older age. These data do not take account of the people with prediabetes who may already have one or more life-limiting diabetes complications at diagnosis. An estimated ~ 20 million people globally need palliative care the year before they die; a further 20 million need end-of-life care per year [2]. The World Health Organization (WHO) estimated that 71% of deaths in 2016 were associated
