Efficacy of a multifactorial strategy for bowel preparation in diabetic patients undergoing colonoscopy: a randomized trial

Abstract

Background and study aims: Previous studies have reported that diabetes mellitus is an independent risk factor for inadequate bowel preparation. Current guidelines do not recommend a specific preparation for this patient population. The aims of this study were to assess the efficacy, safety, and tolerability of an adapted preparation protocol for colon cleansing in patients with type 2 diabetes mellitus. Patients and methods: This randomized, single-blind, parallel group, superiority trial compared a conventional bowel preparation protocol (CBP) with a diabetes-specific preparation protocol (DSP). The CBP included a low-fiber diet for 3 days followed by a clear liquid diet for 24 hours before colonoscopy. The DSP included a multifactorial strategy combining an educational intervention, a low-fiber diet, and adjustment of blood glucose-lowering agents. All patients received 4?L of a polyethylene glycol solution in a split-dose regimen. The endoscopists were blinded to the preparation protocol. The primary outcome measure was inadequate bowel preparation according to the Boston Bowel Preparation Scale. Secondary outcome measures included hypoglycemic events, tolerability, and acceptability. Results: A total of 150 patients were included in the study (74 CBP and 76 DSP). Both groups were comparable in terms of baseline characteristics. Inadequate bowel cleansing was more frequent following CBP than DSP (20?% vs. 7?%, P?=?0.014; risk ratio 3.1, 95?% confidence interval 1.2???8). Only CBP and performance status were independently associated with inadequate bowel preparation. Both preparations were equally tolerated and accepted by patients, and side-effects were similar between the groups. Conclusions: A multifactorial strategy for bowel preparation in patients with diabetes undergoing colonoscopy showed a threefold reduction in the rate of inadequate bowel preparation, with no differences in safety and tolerability compared with conventional preparation. Trial registration: ClinicalTrials.gov (NCT02300779).

Randomized Clinical Trial: A Normocaloric Low-Fiber Diet the Day Before Colonoscopy Is the Most Effective Approach to Bowel Preparation in Colorectal Cancer Screening Colonoscopy

“…It should be pointed out that a previous study demonstrated that an LFD adapted to diabetic patients, together with an educational intervention before colonoscopy, improved bowel cleanliness. 23…”

Impact of opioid use on patients undergoing screening colonoscopy according to the quality of bowel preparation

“…There were also some potential limitations. It is well established that patients with diabetes experience issues with bowel preparation and may require specific preparation regimens . Use of other medications and patients’ functional status may also affect bowel motility; however, comorbidities (e.g.…”

Efficacy and tolerability of various bowel preparations in diabetic patients: a randomized controlled trial

“…Need for colonoscopy is common in patients with DM, given the high prevalence of gastrointestinal symptoms and a possible increased risk of colon cancer 11 12 . Previous studies suggested that the rate of inadequate bowel preparation ranged between 20 % and 38 % in patients with diabetes 13 14 15 16 .…”

“…One recently published study examined the effect of a multifactorial strategy combining an educational intervention, 4 days of a low-fiber diet, and adjustment of blood glucose-lowering agents on the quality of bowel preparation among patients with DM receiving split-dose bowel preparation. The researchers found that the multifactorial strategy resulted in more adequate bowel preparation compared with the conventional protocol: low-fiber diet for 4 days and clear liquid diet the day before the procedure (93 % vs. 80 %, P = 0.014) 15 . Similarly, we found that 82 % of patients in the split-dose groups achieved adequate bowel preparation, which is comparable to the rate of adequate bowel preparation in the Alvarez-Gonzalez study’s standard split-dose treatment arm (80 %).…”