Dying well with diabetes

Dying is an inevitable part of living. How death is experienced is important for the individual, their family and carers and the healthcare professionals who provide care. Much has been written on the palliative care needs at the end of life (1-3). Such guidance is generic and co-existing conditions such as diabetes are not always addressed. In the United States (US), studies decry the lack of quality palliative care for people with conditions such as frailty, cardiopulmonary failure, and end stage renal disease compared with those with dementia or cancer (4). While diabetes is not included in the US article, diabetes complications include cardiovascular disease and renal disease. National consensus guidance on diabetes and end of life was first published in Australia in 2010 (5). National guidance for the care of people with co-morbidities such as diabetes was recommended in 2013 in the United Kingdom (UK); this report demanded condition specific recommendations (6). At that time, “diabetes specific” consensus UK guidance had already been published and was accessible to all health care professionals (7). The American Diabetes Association published a short position statement [2017] on medical standards for adults end of life care giving a summary of recommendations (8). In addition, the International Diabetes Federation made recommendations for end of life care aligned to the UK consensus guidance in 2013 (9)