Perspectives on the Identification of Hypoglycemia Risk in Patients With Type 2 Diabetes Mellitus During the Peri-Colonoscopy Period

Abstract

Yang et al. (2025) recently carried out a retrospective cohort study with the objective of devising a predictive model for evaluating the risk of hypoglycaemia among patients suffering from Type 2 diabetes mellitus in the peri-colonoscopy phase. This study was designed to pinpoint the crucial clinical and demographic elements that contribute to the risk of hypoglycaemia within this particular demographic. By scrutinising data from individuals undergoing colonoscopy, the research team assimilated multiple significant variables into their model to forecast hypoglycaemic incidents. The delineated predictors encompassed insulin utilisation, SGLT2 inhibitors, fasting subsequent to colonoscopy, fasting C-peptide levels and estimated glomerular filtration rate (eGFR). The components were integrated to establish a robust predictive model for evaluating the likelihood of hypoglycaemia during the peri-colonoscopy period. In the development cohort, the model exhibited a robust discriminatory ability, with an area under the receiver operating characteristic curve of 0.78 (95% CI, 0.71–0.84) and in the validation cohort, 0.82 (95% CI, 0.74–0.90). The results indicate that this model may aid clinicians in recognising patients at increased risk for hypoglycaemia, thereby facilitating more precise management strategies and preventive measures. Early identification of at-risk individuals can greatly enhance patient safety, minimise adverse events and improve clinical outcomes during the peri-colonoscopy phase. Based on the important results of Yang et al. (2025), we present several points of view on the thorough evaluation of hypoglycaemia risk inside this specific group.

First, effective monitoring of insulin use depends on doctors closely reviewing the patient's insulin schedule and paying particular attention to any necessary dosage or timing changes before and after the operation. Regular monitoring of blood glucose levels is essential for identifying potential hypoglycaemic episodes, especially in patients with Type 2 diabetes mellitus undergoing colonoscopy. Patients prescribed SGLT2 inhibitors should undergo renal function assessment and maintain adequate hydration, as dehydration may elevate the risk of hypoglycaemia attributable to the medication's diuretic properties. In addition to monitoring blood glucose levels, physicians must also be vigilant for signs of dehydration, such as hypotension and dry mucous membranes. The management of fasting following colonoscopy must be carefully undertaken by ensuring that patients receive appropriate post-procedural nutritional guidance, which encompasses the gradual reintroduction of food to mitigate the risk of hypoglycaemia. Physicians must monitor the length of fasting and begin early feeding for patients who are on insulin or other glucose-lowering medications. Additionally, it is important to monitor fasting C-peptide levels, as low levels indicate compromised endogenous insulin production, which can heighten the risk of hypoglycaemia. It is critical to monitor the eGFR on a frequent basis, as decreased renal function may necessitate dosage modifications for antidiabetic drugs in order to avoid problems. Furthermore, properly addressing the risk of hypoglycaemia in this setting needs coordination across various disciplines, notably with endocrinologists, to ensure optimal therapy and patient safety during the peri-colonoscopy period. Regularly monitoring these key indicators allows physicians to manage hypoglycaemia risk proactively and based on evidence.

Secondly, it is incumbent upon nursing personnel to regularly monitor blood glucose levels, especially among patients utilising insulin, who are at a markedly elevated risk of hypoglycaemia, particularly following extended periods of fasting. The implementation of frequent glucose monitoring facilitates the early detection of hypoglycaemic incidents, thereby enabling prompt intervention to avert severe complications. Any abnormal blood glucose readings, particularly those falling below the standard threshold, should be promptly reported to the medical team to facilitate timely adjustments in treatment or nutritional support. Nurses administering SGLT2 inhibitors must perform thorough assessments of hydration status by carefully monitoring clinical indicators of dehydration. Indicators encompass dry mucous membranes, reduced urine output, hypotension and tachycardia. The induction of glycosuria and osmotic diuresis by SGLT2 inhibitors can increase the risk of hypoglycaemia due to dehydration, highlighting the importance of monitoring fluid balance as a nursing responsibility. Careful consideration is required for the management of fasting after a colonoscopy. Nurses need to collaborate with physicians and dietitians to ensure that patients can promptly return to suitable nutritional intake, thus minimising the risk of hypoglycaemia caused by fasting. It is crucial to monitor C-peptide levels, as consistently low levels indicate impaired endogenous insulin production, increasing the risk of hypoglycaemia. Nursing personnel are essential in preventing and managing hypoglycaemia during the peri-colonoscopy phase by maintaining careful observation, identifying warning signs promptly and promoting effective communication across disciplines, which ultimately improves patient safety.

Third, AI-driven systems (Noseworthy et al. 2022; Bellemo et al. 2019) can integrate both invasive and non-invasive monitoring methods, enabling a transition from episodic testing to continuous, real-time observation. This technique enhances the accuracy and timeliness of hypoglycaemia detection, enabling early intervention and improved patient outcomes. Invasive methods, such as continuous glucose monitoring systems, deliver real-time blood glucose data that AI algorithms can analyse to detect trends, predict impending hypoglycaemic events and generate automatic alerts for healthcare professionals before clinical symptoms manifest. Furthermore, AI-driven analysis of fasting C-peptide levels improves the precision of evaluating endogenous insulin production, aiding in the early identification of patients at increased risk of hypoglycaemia. Non-invasive monitoring methods, including wearable biosensors, infrared spectroscopy and AI-enhanced imaging, provide continuous assessment of hydration levels and metabolic fluctuations, particularly advantageous for patients using SGLT2 inhibitors. AI-powered dietary analysis tools can enhance fasting management by assessing nutritional consumption patterns and fasting length post-colonoscopy, providing tailored suggestions to alleviate fasting-induced hypoglycaemia. Moreover, AI-driven predictive analytics, when combined with clinical decision support systems, can provide early alerts, allowing for prompt and precise interventions. These AI applications provide a proactive and personalised strategy for hypoglycaemia control, thereby improving patient safety, alleviating the burden of diabetes-related comorbidities and advancing precision medicine in metabolic and endocrine care.