Scheduling rules for patients with diabetes mellitus that facilitate split-dosing improve the quality of bowel preparation for colonoscopy

An adequate bowel preparation for colonoscopy is best achieved by giving the cleansing regimen as a split-dose with the second dose given 4-6 hours before the procedure. This can be difficult to administer to diabetics who are preferentially scheduled for early morning procedures. We examined the im...

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Bibliographic Details
Published in:PloS one 2017-07, Vol.12 (7), p.e0182225-e0182225
Main Authors: Hilsden, Robert J, Bridges, Ronald, Dube, Catherine, Heitman, Steven J, Rostom, Alaa
Format: Article
Language:English
Subjects:
Adenoma
Adolescent
Adult
Age
Aged
Appointments and Schedules
Bowel training
Cancer
Cancer screening
Care and treatment
Cathartics - administration & dosage
Cathartics - adverse effects
Cecum
Colon
Colonoscopy
Colonoscopy - adverse effects
Colonoscopy - methods
Colonoscopy - standards
Colorectal cancer
Colorectal carcinoma
Colorectal Neoplasms - diagnosis
Colorectal Neoplasms - epidemiology
Confidence intervals
Diabetes
Diabetes Complications - diagnosis
Diabetes Complications - epidemiology
Diabetes mellitus
Diabetics
Dosage
Drug Administration Schedule
Drug dosages
Endoscopy
Feces
Female
Gastroenterology
Gastrointestinal diseases
Health aspects
Health sciences
Hepatology
Humans
Influence
Intestine
Intestines - drug effects
Intestines - physiology
Male
Medical examination
Medical screening
Medicine
Medicine and Health Sciences
Middle Aged
Morning
Patient outcomes
Patients
People and Places
Polyethylene glycol
Polyps
Quality control
Scheduling
Surveillance
Task forces
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Summary:An adequate bowel preparation for colonoscopy is best achieved by giving the cleansing regimen as a split-dose with the second dose given 4-6 hours before the procedure. This can be difficult to administer to diabetics who are preferentially scheduled for early morning procedures. We examined the impact on bowel preparation quality of scheduling diabetics for mid-morning (9:30 am or later) procedures rather than early morning procedures (7:30-9:00 AM) to facilitate a split-dose preparation. Historical cohort study of 34,415 patients (1,805 diabetics) age 18-74 years without significant comorbidities who underwent an outpatient colorectal cancer screening-related colonoscopy either before (2013) or after (2014) a unit wide change in scheduling practices for diabetics. The primary outcome was the rate of inadequate bowel preparation. Secondary outcomes include the rate of procedures complete to the cecum, procedure duration and detection rates of polyps, any colorectal cancer screening-relevant lesion (adenoma, sessile serrated adenoma, large proximal hyperplastic polyp) and advanced adenomas. From 2013 to 2014, the proportion of diabetics with an inadequate bowel preparation decreased from 7.7% to 3.2% (95% confidence interval for the difference 2.2%-6.8%, P
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0182225