Medical Updates (2) - Diabetes at the End of Life: What’s New?
Diabetes is common in people receiving palliative and end-of-life care, but management priorities change substantially as patients approach the end of life. Decisions increasingly focus on comfort, avoiding symptomatic hyperglycaemia and hypoglycaemia, reducing treatment burden and maintaining dignity, rather than preventing long-term complications. This session will provide an update following revision of the Palliative Care Formulary chapter on Drugs and Diabetes Mellitus, highlighting developments particularly relevant to current clinical practice. A key focus of this session will be the increasing use of continuous glucose monitoring (CGM), wearable technology, and insulin pumps. These technologies may reduce the burden of capillary blood glucose monitoring and support safer insulin management, but their role in hospice and end-of-life care is evolving. The session will consider practical indications for CGM, including when it may be helpful in the last months or weeks of life, and when technology may instead represent unnecessary complexity or burden. The update will also highlight type 3c diabetes, which is particularly relevant in patients with pancreatic disease and pancreatic cancer. Its recognition is important because pancreatic damage, insulin deficiency and altered nutritional intake can create significant challenges, including increased risk of hypoglycaemia. Additionally, the session will address the emerging challenge of immune checkpoint inhibitor-associated diabetes. Immunotherapy can cause abrupt autoimmune, insulin-deficient diabetes, which may present with diabetic ketoacidosis. This can occur in older, multimorbid patients with advanced cancer, creating complex decisions about insulin treatment alongside changing goals of care. By combining these developments with practical principles for continuing, simplifying or stopping diabetes treatment, the session will provide clinicians with an updated, patient-centred approach to diabetes management in palliative care.

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