What are the priorities for managing diabetes in a person approaching the end of life, and what glucose range is suggested by TREND guidelines?

Priorities are to keep the person safe, avoid osmotic symptoms, hypoglycaemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycaemic state (HHS). TREND guidelines suggest glucose levels no less than 6 mmol/L and no more than 15 mmol/L, with allowance for individualization following end-of-life planning review.

For a person approaching the end of life, defined as likely to die within the next 12 months and including those with imminent death or general frailty and coexisting conditions, the clinical priorities are avoiding harm and distress. These priorities are specifically to keep the person safe, avoid osmotic symptoms, avoid hypoglycaemia, avoid diabetic ketoacidosis, and avoid hyperosmolar hyperglycaemic state. TREND guidance from 2024 recommends glucose levels be kept no less than 6 mmol/L and no more than 15 mmol/L, though this target can be individualized following an end-of-life planning review.