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Diabetes-related symptoms, acute complications and management of diabetes mellitus of patients who are receiving palliative care: a protocol for a systematic review
  1. Rita Bettencourt-Silva1,2,
  2. Beatriz Aguiar3,
  3. Vânia Sá-Araújo4,
  4. Rosa Barreira5,
  5. Vânia Guedes6,
  6. Maria João Marques Ribeiro7,
  7. Davide Carvalho2,8,
  8. Linda Östlundh9,
  9. Marília Silva Paulo10,11
  1. 1 Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário São João, Porto, Portugal
  2. 2 Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
  3. 3 Unidade de Saúde de Ilha de São Miguel, Unidade de Saúde de Rabo de Peixe, Ribeira Grande, São Miguel, Açores, Portugal
  4. 4 Department of Palliative Care, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
  5. 5 Unidade de Saúde Familiar Maresia, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
  6. 6 Unidade de Saúde Familiar São João do Porto, Agrupamento de Centros de Saúde (ACES) do Porto Ocidental, Porto, Portugal
  7. 7 Department of Medical Oncology, Centro Hospitalar Universitário São João, Porto, Portugal
  8. 8 Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
  9. 9 National Medical Library, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi, United Arab Emirates
  10. 10 Institute of Public Health, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, United Arab Emirates
  11. 11 Universidade Nova de Lisboa Instituto de Higiene e Medicina Tropical, Lisboa, Portugal
  1. Correspondence to Marília Silva Paulo; mariliap{at}


Introduction Worldwide, an estimated 40 million people are in need of palliative care each year, but only 14% receive it. The incidence of diabetes mellitus (DM) in patients receiving palliative care is higher than in the general population. This association is intended to grow as a result of the rising burden of DM worldwide, ageing populations and the improved overall survival time of several diseases over the last few decades. Recommendations for DM management in the context of palliative care are mainly based on expert opinion as there is a lack of suitable evidence base and randomised clinical trials in palliative care are scarce. The aim of our systematic review is to identify the best DM management practices in order to reduce important DM-related symptoms and acute complications in patients receiving palliative care.

Methods and analysis The authors will study the DM treatment and management literature, surveying the different approaches employed to treat adult palliative patients. Core health bibliographic databases will be searched from January 1990 to May 2019. Data sources will include Ovid MEDLINE, Embase, PubMed, Web of Sciences, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, Cumulative Index to Nursing and Allied Health Literature and grey literature. Details regarding diet, oral and injectable glucose-lowering medicines, insulin regimens and blood glucose monitoring strategies will be evaluated. We defined the primary outcomes to compare between DM management approaches as the presence of symptoms (polyuria, polydipsia and polyphagia) and acute complications of DM (hypoglycaemia, hyperglycaemic hyperosmolar state and diabetic ketoacidosis), and secondary outcomes as hospital admissions and deaths due to DM-related complications, health-related quality of life and glycaemic control.

Ethics and dissemination The systematic review methodology does not require ethics approval due to the nature of the study design. The results of the systematic review will be published in a peer-reviewed journal and will be publicly available.

PROSPERO registration number CRD42018115772.

  • palliative care
  • adult palliative care
  • general diabetes

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  • Contributors RB-S is the primary author for the study. RB-S and MSP conceived, designed the study and drafted the protocol. MSP is the corresponding author. LÖ performed the full search strategy for each database. LÖ provided feedback on study protocol design and critically revised earlier versions of the manuscript. BA, VS-A, RB, VG, MJMR and DC critically revised earlier drafts of the manuscript for intellectual content. All the authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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