DIABETES MELLITUS – A RISK FACTOR FOR POOR BOWEL PREPARATION?

Aims:

Adequate bowel preparation is the most important prerequisite for a successful colonoscopy. Patient-related factors contribute to poor bowel preparation. Among these, diabetes mellitus (DM) could predispose to a poor bowel preparation due to inability to maintain fasting and autonomous neuropathy with consequent bowel paresis. Our aim was to assess bowel preparation in patients with DM.

Methods:

During a 3 months period, we recruited patients with and without DM who underwent total colonoscopy. A split-dose regimen with 4 liters polyethylene glycol (PEG) was used for colon cleansing. Bowel preparation was reported according to Boston Bowel Preparation Scale (BBPS). Patients with incomplete colonoscopy and those in whom the Boston score wasn't recorded in the colonoscopy report were excluded.

Results:

Altogether 250 patients were recruited, 38 (15.2%) with DM and 212 (84.4%) without DM, mean age 59 ± 13 years, 43.6% female. Of the DM patients, 36 (95%) had type II DM, six were insulin dependent and the rest were on oral hypoglycemic agents. Average BBPS was 6.2 (median 6.5, interquartile range 5.5 – 7) in patients with DM and 7.09 (median 7, 6.5 – 8) in those without (p = 0.0045). Poor bowel preparation (BBPS< 6) was seen in 12 (31.6%) of patients with DM, compared to 28 (13.2%) of patients without DM (p < 0.01). Bowel preparation subscores were lower in the left and right colon of DM patients compared with non-DM group – 1.81 versus 2.28, and 1.92 versus 2.26, respectively (p < 0.01); however, there was no significant difference in the cleansing of transverse colon among the two groups – 2.52 versus 2.53.

Conclusions:

In our study, poor bowel preparation was more frequently seen in patients with DM compared to non-DM, particularly for left and right colon segments. Optimization of current bowel cleansing regimens should be considered in DM patients.