Guidelines for Deciding Palliative and End of Life Care with People with Diabetes

Diabetes is an important chronic disease, arguably the most important. We manage chronic disease - but we don’t cure it. It is the nature of chronic diseases that they persist and progress. Commonly culminating in death. Without this recognition we ceaselessly ramp up intervention. In the process we can easily make ‘endings’ very invasive and highly technological—often very different from what the person with diabetes desires. Without thought we trade dignity, dependence and comfort for a longer, but miserable, existence. We lose sight of humanity. Of course, some of us DO want ‘everything’ done as things fall apart, but research tells us that this is a small minority (about 7%). The remaining 93% want something less than ‘everything’, and we need to ask them what they do want and what they do not want. Asking and listening are central to the concept of patient-centred care, driving a logical and compassionate transition to palliative care. The 2016 ‘National Strategy for Chronic Conditions’ established the national policy platform to 2025. It advocates early detection, [which is very appropriate], and better long term management, [which is admirable]… but that’s it … there is no more. There is ‘no end’ in the strategy. It seems as if we do better we can live forever. Death is never mentioned. Unfortunately, these things matter. Strategy drives funding and strategy drives action. In the absence of relevant strategies this guideline is particularly important. The authors explained the issues in simple but persuasive terms for patients, families and doctors and other clinicians.