P0550 - The Impact of Glycemic Control on the Quality of Bowel Preparation in Patients Undergoing Elective Colonoscopy: A Retrospective Multi-Center Study

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

YS

Yash R. Shah, MD

Trinity Health Oakland/Wayne State University
Pontiac, MI

Yash R. Shah, MD¹, Mones Takriti, MD, FACG², Dushyant Singh. Dahiya, MD³, Hassam Ali, MD⁴, Saurabh Chandan, MD⁵, Kelly Parker, DO⁶, Jennifer de Longpre, DO⁶, Anupam Sule, MD, PhD², Geetha Krishnamoorthy, MD¹
¹Trinity Health Oakland/Wayne State University, Pontiac, MI; ²Trinity Health Oakland, Pontiac, MI; ³University of Kansas School of Medicine, Kansas City, KS; ⁴ECU Health Medical Center / Brody School of Medicine, Greenville, NC; ⁵Creighton University School of Medicine, Omaha, NE; ⁶Trinity Health Muskegon Hospital, Muskegon, MI

Introduction: Diabetes Mellitus (DM) can slow intestinal transit and delay gastric emptying potentially affecting the quality of bowel preparation (QBP) for colonoscopy. Suboptimal bowel preparation (BP) may lead to missed neoplastic or preneoplastic lesions. This study evaluates glycemic control’s impact on QBP in patients undergoing elective colonoscopy.

Methods: A retrospective review of patients who underwent elective colonoscopy with HbA1c levels within one year of the procedure across eight hospitals was conducted. QBP was categorized as optimal or suboptimal based on the Boston Bowel Preparation and Ottawa Bowel Preparation Scales. The association between glycemic control, defined as Hba1c < 5.7 or FBS < 100 mg/dL (Non-diabetic); Hba1c: 5.7-6.4% or FBS: 100-125 mg/dL (Pre-diabetes); Hba1c: 6.5-9.5% or FBS: 126 mg/dL-225 mg/dL (Well-controlled diabetes); Hba1c: >9.5% or FBS >225 mg/dL (Poorly controlled diabetes), and QBP was investigated, along with other patient demographic and clinical characteristics. Socioeconomic status was decided based on the insurance coverage carried by the patient. Significance was assessed at p< 0.05. 

Results: A total of 1458 patients were included in the analysis [Table 1]. QBP was suboptimal in 98 (6.7%) patients. Average days between HbA1c or FBS and colonoscopy  were 119.4±89.2. Overall, optimal QBP rates were higher in poorly controlled diabetics (79.5% vs 20.5%, p< 0.001) compared to suboptimal QBP. However, non-diabetics (6.9%), pre-diabetics (4.8%) and well-controlled diabetics (7.7%), had lower rates of suboptimal QBP as compared to poorly controlled diabetics (20.5%). Patients from low socioeconomic status had higher rates of optimal QBP (90.7% vs 9.3%, p< 0.001) but higher rates of suboptimal QBP compared to high socioeconomic status patients (4.7%). Additionally, diabetics on insulin had higher rates of optimal QBP (78.1% vs 21.9%, p< 0.001) but higher rates of suboptimal QBP compared to non-insulin dependent diabetics (5.5%). There were no statistical differences in the QBP rates for age, gender, BMI and patients on GLP-1 agonists.

Discussion: This study shows that poorly controlled and insulin-dependent diabetics have higher rates of suboptimal QBP, leading to missed lesions and increased colon cancer risk. Limited access to healthcare due to low socioeconomic status indirectly contributes to poorly controlled DM and higher rates of suboptimal QBP. Identifying poor preparation risks allows targeted interventions to enhance QBP in high-risk patients.

Patient Characteristics	Overall	Optimal Bowel Prep Quality	Suboptimal Bowel Prep Quality	'P' Value
Age (Mean±SD) in years	59.9±9.6	59.96±9.51	58.45±10.25	0.132
Sex Female Male	54.8% 45.2%	94.1% 92.3%	5.9% 7.7%	0.159
Socioeconomic Status Low High	44.2% 55.8%	90.7% 95.3%	9.3% 4.7%	< 0.001
BMI (n=1407) Underweight (< 18.5) Healthy Weight (18.5-24.9) Overweight (25-29.9) Obese ( >30)	0.4% 15.3% 31.9% 52.4%	100% 94.4% 93.3% 92.7%	0% 5.6% 6.7% 7.3%	0.736
Glycemic Control Non-diabetic Pre-diabetes Well Controlled Diabetes Poorly Controlled Diabetes	39.5% 35.7% 22.2% 2.7%	93.1% 95.2% 92.3% 79.5%	6.9% 4.8% 7.7% 20.5%	< 0.001
Insulin Yes No	7.2% 92.8%	78.1% 94.5%	21.9% 5.5%	< 0.001
GLP1 Agonist Yes No	4.5% 95.5%	89.2% 93.5%	7.1% 6.5%	0.198

Table: Table 1: Patient characteristics and comparative analysis of optimal and suboptimal bowel preparation groups (BMI: Body Mass Index, FBS: Fasting Blood Glucose, GLP-1: Glucagon Like Peptide 1)

Disclosures:

Yash Shah indicated no relevant financial relationships.

Mones Takriti indicated no relevant financial relationships.

Dushyant Dahiya indicated no relevant financial relationships.

Hassam Ali indicated no relevant financial relationships.

Saurabh Chandan indicated no relevant financial relationships.

Kelly Parker indicated no relevant financial relationships.

Jennifer de Longpre indicated no relevant financial relationships.

Anupam Sule indicated no relevant financial relationships.

Geetha Krishnamoorthy indicated no relevant financial relationships.

Yash R. Shah, MD¹, Mones Takriti, MD, FACG², Dushyant Singh. Dahiya, MD³, Hassam Ali, MD⁴, Saurabh Chandan, MD⁵, Kelly Parker, DO⁶, Jennifer de Longpre, DO⁶, Anupam Sule, MD, PhD², Geetha Krishnamoorthy, MD¹. P0550 - The Impact of Glycemic Control on the Quality of Bowel Preparation in Patients Undergoing Elective Colonoscopy: A Retrospective Multi-Center Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.