Peri-colonoscopy hypoglycaemia in type 2 diabetes: Temporal patterns and asymptomatic presentation

doi:10.4239/wjd.121326

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Publication Name

World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Diabetes. Aug 15, 2026; 17(8): 121326
Published online Aug 15, 2026. doi: 10.4239/wjd.121326

Peri-colonoscopy hypoglycaemia in type 2 diabetes: Temporal patterns and asymptomatic presentation

Hai-Yan Yang, Lin-Lin Zhang, Shu-Qiao Hu, Qiu-Ping Yang, De-Liang Liu

Hai-Yan Yang, Lin-Lin Zhang, Shu-Qiao Hu, Qiu-Ping Yang, De-Liang Liu, Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, Guangdong Province, China

Co-first authors: Hai-Yan Yang and Lin-Lin Zhang.

Author contributions: Yang HY and Zhang LL wrote the manuscript as co-first authors; Yang HY, Zhang LL, and Hu SQ performed the data collection; Yang HY and Yang QP analyzed the data; Yang HY and Liu DL designed the research study; Liu DL supervised the study and revised the manuscript; all authors have read and approved the final manuscript.

AI contribution statement: I have fully rewritten the entire point-by-point response to reviewers independently by the authors, without using any AI tools for writing, paraphrasing, translation or language polishing. All reply content and revision arrangements remain consistent with the revised manuscript.

Supported by Sanming Project of Medicine in Shenzhen, No. SZZYSM202411016.

Institutional review board statement: The study was reviewed and approved by the Shenzhen Traditional Chinese Medicine Hospital Institutional Review Board (approval No. K2022-148-01).

Informed consent statement: The requirement for informed consent was waived by the Institutional Review Board due to the retrospective nature of this study.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: The datasets used during the current study are available from the corresponding author on reasonable request. Participants’ consent was not obtained, but the presented data are anonymized and the risk of identification is low.

Corresponding author: De-Liang Liu, PhD, Associate Professor, Chief Physician, Head, Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, No. 1 Fuhua Road, Futian District, Shenzhen 518033, Guangdong Province, China. ldl2580@gzucm.edu.cn

Received: March 23, 2026
Revised: April 22, 2026
Accepted: June 22, 2026
Published online: August 15, 2026
Processing time: 137 Days and 4.3 Hours

Abstract

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) undergoing colonoscopy face an elevated risk of hypoglycaemia due to prolonged fasting and bowel preparation. However, the temporal distribution of hypoglycaemic events across the peri-colonoscopy period and the prevalence of asymptomatic hypoglycaemia in this setting remain poorly characterised.

AIM

To describe the temporal distribution of hypoglycaemic events during the peri-colonoscopy period and to identify factors associated with asymptomatic hypoglycaemia.

METHODS

This retrospective cohort study included 851 hospitalised adults with T2DM who underwent colonoscopy between January 2021 and December 2025 at a tertiary hospital in China. The peri-colonoscopy period was divided into five clinical phases. Phase-specific incidence rates were calculated per 1000 patient-hours. Generalised estimating equations were used to identify factors associated with asymptomatic presentation.

RESULTS

Overall, 159 patients (18.7%) experienced 181 hypoglycaemic events, of which 54.1% were asymptomatic. The immediate post-colonoscopy phase (0-6 hours) had the highest incidence rate (6.93 per 1000 patient-hours), while the early bowel preparation phase (20:00-06:00) had the highest asymptomatic proportion (70.5%). In multivariable analysis, diabetes-related retinopathy [odds ratio (OR) = 3.19, 95%CI: 1.58-6.41, P = 0.001] and nocturnal occurrence (OR = 3.58, 95%CI: 1.83-7.00, P < 0.001) were independently associated with asymptomatic presentation, whereas level 2 hypoglycaemia was inversely associated (OR = 0.30, 95%CI: 0.12-0.76, P = 0.012). Risk stratification showed asymptomatic proportions ranging from 31.8% to 84.2% (P for trend < 0.001).

CONCLUSION

More than half of peri-colonoscopy hypoglycaemic events were asymptomatic among hospitalised patients with T2DM. Patients with retinopathy and nocturnal events may require intensified glucose monitoring regardless of symptom reporting; these findings should be interpreted in the context of inpatient colonoscopy care.

Keywords: Type 2 diabetes mellitus; Colonoscopy; Asymptomatic hypoglycaemia; Temporal distribution; Risk stratification; Peri-colonoscopy period; Glucose monitoring; Impaired awareness of hypoglycaemia

Core Tip: This study reveals that more than half (54.1%) of hypoglycaemic events during the peri-colonoscopy period in hospitalised patients with type 2 diabetes mellitus were asymptomatic, representing a substantial monitoring blind spot. Two distinct high-risk windows were identified: (1) The immediate post-colonoscopy phase (highest incidence); and (2) The early bowel preparation period (highest asymptomatic proportion). Diabetes-related retinopathy and nocturnal occurrence were independently associated with asymptomatic presentation, enabling an exploratory risk stratification from 31.8% to 84.2% asymptomatic proportions. These findings support prospective evaluation of phase-specific, risk-stratified glucose monitoring protocols in hospitalised patients.