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There is limited evidence regarding the optimal timing and process for de-escalation of blood sugar monitoring and diabetes medications (including insulin) in the hospice and EOL setting. Rather, decisions are guided by prognosis, impacts of hypo- or hyperglycemia on a particular patient\u2019s symptoms, and the burdens of specific diabetes medications or interventions. Shared decision-making with patients and care partners is essential, as is addressing the emotional impact of changes to diabetes routines, which some patients have adhered to for many years. Diabetes also impacts overall symptom control at EOL. These ten tips guide palliative care clinicians to identify and address the impact of glycemic control, diabetes medications, and common long-term complications of diabetes on symptom burden.<\/jats:p>","DOI":"10.1089\/jpm.2025.0226","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T03:25:32Z","timestamp":1750908332000},"page":"675-681","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Top Ten Tips Palliative Care Clinicians Should Know About Managing Diabetes at End-of-Life"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0209-8481","authenticated-orcid":false,"given":"Rebekka","family":"DePew","sequence":"first","affiliation":[{"name":"Department of Family and Preventive Medicine, Division of Palliative and Supportive Care, Emory University, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonya","family":"Hershman","sequence":"additional","affiliation":[{"name":"Department of Family and Preventive Medicine, Division of Palliative and Supportive Care, Emory University, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Giles","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Emory University, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0680-8911","authenticated-orcid":false,"given":"William E.","family":"Rosa","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Curseen","sequence":"additional","affiliation":[{"name":"Division of Palliative and Supportive Care, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"CDC. 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