Abnormal Blood Sugar Tests in Diabetic Patients During Colonoscopy Preparation
Condition: Type 2 Diabetes Mellitus; Colonoscopy
MeSH terms: Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      Type 2 diabetes is rapidly increasing globally and has been associated with an increased risk
      of colorectal cancer. Therefore, the numbers of diabetic patients who will undergo
      colonoscopic screening are expected to grow exponentially. Colonoscopic preparation entails
      prolonged fasting, cessation of anti-diabetic medication and ingestion of preparation
      medications. This may put the diabetic patient at risk of potentially dangerous hypo- or
      hyperglycemia. However, studies regarding the safety of colonoscopic preparation in diabetic
      are lacking. In this study, the investigators aim to discover the prevalence of abnormal
      glucose levels in diabetic patients who undergo colonoscopy. The investigators also aim to
      find out risk factors for abnormal glucose levels and develop a safe preparation protocol.
    

Detailed description: 
      1. Type 2 diabetes subjects who will undergo colonoscopy will be prospectively enrolled
           when visiting the outpatient clinic.

        2. Subjects will be instructed to fast from 6pm of the day before colonoscopy.

        3. Subjects will be instructed to abstain from diabetes medication while the subjects fast.

        4. Subjects who are scheduled to undergo colonoscopy in the morning will take colonoscopy
           preparation medication (2L (liter) of polyethylene glycol with ascorbic acid) in a split
           dose (i.e. 1L from 8-10 pm of the day before colonoscopy and 1L 4-6 hours before
           colonoscopy). Those who will undergo colonoscopy in the afternoon will take 2L of the
           preparation medication 6 hours before colonoscopy.

        5. Subjects will be instructed to take the preparation medication at rate of 250 mL every
           10 to 15 minutes.

        6. Upon arrival at the endoscopy center of International St. Mary's hospital, subjects will
           be given a self-administered questionnaire which will ask about their age, gender,
           duration of diabetes, type of diabetes medication, time of last diabetes medication
           taken, knowledge of hypo/hyperglycemia symptoms, previous hypo/hyperglycemia experience,
           self-treatment of hypoglycemia (if done), total amount of colonoscopy preparation
           medication ingested, total fasting time and time of last preparation medication
           ingested.

        7. Subjects will have vital signs (blood pressure, heart rate) taken and their capillary
           glucose levels checked using the Accu-Chek Performa.

        8. Any subjects with capillary glucose levels <70mg/dL or >250mg/dL will be reported to the
           attending physician. Those with an initial glucose level <70mg/dL will be given a piece
           of candy and have their glucose rechecked in 10 mins. Subjects will be asked if the
           hypoglycemic symptoms (if any) have abated. Those with a glucose level >250mg/dL will
           undergo hydration with normal saline at 120 ml/Hr. Those who do not respond to treatment
           or are in critical condition will be moved to the Emergency department for treatment.
           Subjects who respond to treatment will have their glucose levels checked after
           colonoscopy before undergoing discharge. Those with abnormal levels upon follow-up
           testing will be sent to either the endocrinology outpatient clinic or the emergency room
           depending on their clinical severity.

        9. All data will be recorded by initials with patient identities masked. All data will be
           kept in a locked and secure location by the principal investigator.
    

Intervention name(s): Colonoscopy preparation using polyethylene glycol
Intervention type(s): Drug
Intervention description(s): Colonoscopy preparation using standard preparation with 2L of polyethylene glycol.
Other intervention name(s): Have not taken diabetes medication since 6pm of the day before colonoscopy.; Have fasted since 6pm of the day before colonoscopy.
Intervention model: Single Group Assignment
Intervention model description: Single group
Masking: None (Open Label)
Primary purpose: Other
Keywords: Type 2 diabetes; colonoscopy; hypoglycemia; hyperglycemia; polyethylene glycol