Postgraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Department of Palliative Care, Bruyère Continuing Care, Ottawa, Ontario, Canada.
J Palliat Med. 2019 Sep;22(9):1133-1138. doi: 10.1089/jpm.2018.0614. Epub 2019 Mar 20.
The prevalence of diabetes mellitus (DM) is rising with an increased risk of developing it as a person ages. Therefore, more persons will have comorbid DM throughout their health journey and are potentially prone to unpleasant symptoms associated with poor glycemic control at the end of life (EOL). We performed an in-depth literature review to examine evidence-based recommendations on DM management at the EOL. A librarian-assisted systematic and gray literature search was performed in electronic clinical databases and Google™ for diabetes management articles (DMAs). National and international diabetes, palliative care, and general guideline websites were searched for clinical practice guidelines (CPGs). Inclusion criteria: adults ≥18 years with terminal illnesses, articles published between 2007 and 2017 with blood sugar target, monitoring frequency, and management recommendations for type 1 and type 2 DM. Exclusion criteria: conference poster abstracts and CPGs without published year or references. Two independent appraisers evaluated the CPGs using the "Rigour of Development" domain of the Appraisal of Guideline Research and Evaluation II (AGREE II) instrument. Nine full-text DMAs were included for review from 2476 screened articles. Twenty-one CPG websites were searched. For the six included CPGs, the AGREE II "Rigour of Development" domain scores ranged from 6% to 34%. We found no high-quality evidence for DM management at the EOL. Treatment recommendations were based primarily on expert opinion (level IV evidence). Higher quality studies are required to inform a standardized approach to the management of DM at the EOL.
糖尿病（DM）的患病率随着人口老龄化而增加，患该病的风险也随之增加。因此，在整个健康旅程中，会有更多的人患有合并 DM，并可能在生命末期（EOL）因血糖控制不佳而出现不良症状。我们进行了深入的文献回顾，以研究 EOL 时 DM 管理的循证建议。在电子临床数据库和 Google™中，由图书管理员协助进行了系统和灰色文献搜索，以查找糖尿病管理文章（DMAs）。搜索了国家和国际糖尿病、姑息治疗和一般指南网站，以查找临床实践指南（CPGs）。纳入标准：患有终末期疾病的成年患者（≥18 岁），发表时间在 2007 年至 2017 年之间，血糖目标、监测频率以及 1 型和 2 型 DM 的管理建议。排除标准：会议海报摘要和没有发布年份或参考文献的 CPG。两名独立评估员使用评估指南研究和评估 II（AGREE II）工具的“开发严谨性”领域评估 CPG。从 2476 篇筛选文章中，共纳入了 9 篇完整的 DMAs 进行综述。共搜索了 21 个 CPG 网站。对于纳入的 6 个 CPG，AGREE II“开发严谨性”领域的评分范围从 6%到 34%。我们没有发现 EOL 时 DM 管理的高质量证据。治疗建议主要基于专家意见（IV 级证据）。需要进行更高质量的研究，为 EOL 时 DM 的管理提供标准化方法。
