Rationalising oral antihyperglycaemic drugs in palliative care

Follow the principles of rationalising antihyperglycaemic drugs when rationalising oral antihyperglycaemics in palliative care.

During the last months of life, patients usually have a reduction in appetite and weight, and may develop liver or kidney impairment. These factors can help prioritise which oral antihyperglycaemic drugs to deprescribe; for example:

• the risk of hypoglycaemia associated with sulfonylureas becomes more significant as dietary intake reduces
• the benefit of sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in promoting satiety and weight reduction may now be a disadvantage
• as kidney function declines, the risk of lactic acidosis with metformin increases.

For patients taking oral antihyperglycaemic drugs and insulin, it is generally simpler to switch to sole therapy with insulin.

By the last days of life, all oral antihyperglycaemic drugs should have been stopped.