Diabetes and Palliative Care

Study Overview
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Brief Summary
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Diabetes prevalence in palliative care is 10-15%. Most hospice patients are treated with insulin. The target glucose level is high in order to decrease the risk of hypoglycemia. Glucose level is usually monitored using capillary blood glucose once to three times daily. The aim of the research is to simplify this pattern of care in end-of-life patients. It will evaluate whether the non invasive measurement of glucose in urine could replace the measurement of capillary blood glucose. The first objective will be to assess the performance of the measurement of glucosuria using urinary dip stix to predict that the blood glucose level is within the target range. Due to the high glucose target, hyperglycemia is extremely frequent. However, symptoms of hyperglycemia are unfrequently reported. They may be unspecific and/or masked in end-of-life patients due to terminal disease and medication. The second objective of the study will be to define symptoms of hyperglycemia in these patients.

Detailed Description
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This is a prospective study involving several palliative care units in France. Glycemia and glycosuria will be measured in the same patients. Symptoms that could be related to hyperglycemia will be assessed in relation with the concomitant blood glucose level. Main investigations : Glycosuria and cetonuria will be measured using a dip stix during each nursing care. Glycemia will be measured before breakfast and before diner. Pain caused by finger pricking for the measurement of glycemia will be evaluated using a verbal scale. Symptoms will be evaluated at the time of each glucose measurement first with open questions then with a list of potential symptoms of hyperglycemia.

Official Title
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Comparison of Glycosuria and Capillary Blood Glucose in Hospitalised Diabetic Patients

Conditions
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End-of-life, Diabetes, Terminal Cancer

Intervention / Treatment
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* Other: diagnosis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: diabetic patients hospitalised in a palliative care unit terminally ill with cancer with blood glucose measurement at least twice daily over 5 days agreeing to participate in the study Exclusion Criteria: patient unable to communicate, to understand information about the study or to decline participation in the study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: diagnosis|Measurement of glycosuria|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Predictive performance of glycosuria measured on urine collected between 10 am and 16 am on the blood glucose level at 6 pm | Glycosuria will be assessed using Ketodiabur 5000 urinary dip stix. The results are semi-quantitative with 8 levels of glycosuria ranging from 0% to 2% (weight/volume). Capillary blood glucose level will be assessed using a glucose meter based on glucose oxydase. | over 12 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Relation between glycemia and glycosuria at different time points over 24 hours. | Glycemia and glycosuria will be assessed as described above. | over 12 days | 
| Intensity of pain caused by finger pricking | Intensity of pain will be assessed using a simple numerical scale. | 12 days | 
| Type, frequency and intensity of symptoms in relation to the blood glucose level | Intensity of symptoms will be assessed using a simple numerical scale. | 12 days |