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Research Letter
May 2018

Hypoglycemia in Hospice Patients With Type 2 Diabetes in a National Sample of Nursing Homes

Author Affiliations
  • 1Department of Medicine, Massachusetts General Hospital, Boston
  • 2Department of Medicine, University of California, San Francisco, San Francisco
  • 3Healthcare Department, Philips Research China. Shanghai, China
  • 4San Francisco Veterans Affairs Medical Center, San Francisco, California
JAMA Intern Med. 2018;178(5):713-715. doi:10.1001/jamainternmed.2017.7744

Approximately one-quarter of the US population die in nursing homes,1 where end-of-life care is of variable quality.2 In particular, it is unknown whether patients with chronic illness, such as diabetes, continue to receive burdensome testing and treatment after transitioning to hospice care in nursing homes. Experts and the American Diabetes Association recommend relaxing glycemic control target levels for patients with diabetes and advanced disease and eventual discontinuation of medications as patients near death to avoid hypoglycemia.3,4 Hypoglycemia causes symptoms of weakness, diaphoresis, confusion, shakiness, and dizziness,5 and is a potentially preventable cause of suffering among hospice patients. Whether nursing home patients with type 2 diabetes on hospice are assessed for dysglycemia, receive insulin or oral hypoglycemic medications, or experience hypoglycemia and hyperglycemia has not previously been described.