Original Article

Efficacy and Safety of Sodium Phosphate for Colon Cleansing in Type 2 Diabetes Mellitus

Authors: Nevin Akcaer Ozturk, MD, Huseyin Savas Gokturk, MD, Mehmet Demir, MD, Gulhan Kanat Unler, MD, Gurden Gu,r MD, Ugur Yilmaz, MD

Abstract


Objectives: The need for colonoscopy is common among diabetic patients. However, there are no standards per se for bowel preparation in patients with type 2 diabetes. In this study, we evaluated the efficacy, safety, and tolerability of sodium phosphate (NaP), and the quality of bowel cleansing in relation to glycemic control and late complications.


Methods: A total of 50 consecutive type 2 diabetic patients and 50 non-diabetic patients underwent bowel preparation by NaP. Fasting blood glucose, sodium (Na), potassium (K), calcium (Ca), phosphorus (P), magnesium, and creatinine levels were measured on the procedure day. Patients were given a tolerability questionnaire regarding symptoms.


Results: With regard to bowel preparation quality, optimal bowel cleansing was achieved in 35 (70%) diabetic and 47 (94%) non-diabetic patients (P = 0.002). Abdominal pain or discomfort during and an hour after the procedure was similar in both groups (P >0.05). The changes in Na, K, Ca, P and creatinine levels after NaP use did not reach statistical significance between the groups (P >0.05). In the diabetic patients, there was a significant correlation between the quality of bowel cleansing and mean age, duration of diabetes mellitus, level of hemoglobin A1c (HbA1c), fasting blood glucose level, and diabetic late complications (P <0.05).


Conclusion: These data suggest that NaP is safe and tolerable in diabetic patients, but the quality of bowel cleansing is worse than in non-diabetic patients. These observations support the concept that the quality of bowel cleansing in those with type 2 diabetes is closely related to the duration and regulation of the disease and the presence of late complications.



This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Kim WH, Cho YJ, Park JY, et al. Factors affecting insertion time and patient discomfort during colonoscopy. Gastrointest Endosc 2000;52:600–605.
 
2. Rex DK, Imperiale TF, Latinovich DR, et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol 2002;97:1696–1700.
 
 
3. Byrne MF. The curse of poor bowel preparation for colonoscopy. Am J Gastroenterol 2002;97:1587–1590.
 
4. Enck P, Rathmann W, Spiekermann M, et al. Prevalence of gastrointestinal symptoms in diabetic patients and non-diabetic subjects. Z Gastroenterol 1994;32:637–641.
 
5. Bytzer P, Talley NJ, Leemon M, et al. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med 2001;161:1989–1996.
 
6. Feldman M, Schiller LR. Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 1983;98:378–384.
 
7. Folwaczny C, Riepl R, Tschöp M, et al. Gastrointestinal involvement in patients with diabetes mellitus: part I (first of two parts). Epidemiology, pathophysiology, clinical findings. Z Gastroenterol 1999;37:803–815.
 
8. Sims MA, Hasler WL, Chey WD, et al. Hyperglycemia inhibits mechanoreceptor-mediated gastrocolonic responses and colonic peristaltic reflexes in healthy humans. Gastroenterology 1995;108:350–359.
 
9. Vinik AI, Erbas T. Recognizing and treating diabetic autonomic neuropathy [Review]. Cleve Clin J Med 2001;68:928–930, 932, 934–944.
 
10. Vinik AI, Maser RE, Mitchell BD, et al. Diabetic autonomic neuropathy. Diabetes Care 2003;26:1553–1579.
 
11. La Vecchia C, Negri E, Decarli A, et al. Diabetes mellitus and colorectal cancer risk. Cancer Epidemiol Biomarkers Prev 1997;6:1007–1010.
 
12. Will JC, Galuska DA, Vinicor F, et al. Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol 1998;147:816–825.
 
13. Le Marchand L, Wilkens LR, Kolonel LN, et al. Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer. Cancer Res 1997;57:4787–4794.
 
14. Taylor C, Schubert ML. Decreased efficacy of polyethylene glycol lavage solution (golytely) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study. Am J Gastroenterol 2001;96:710–714.
 
15. Ma RC, Chow CC, Yeung VT, et al. Acute renal failure following oral sodium phosphate bowel preparation in diabetes. Diabetes Care 2007;30:182–183.
 
16. Vanner SJ, MacDonald PH, Paterson WG, et al. A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (golytely) in the preparation of patients for colonoscopy. Am J Gastroenterol 1990;85:422–427.
 
17. Cohen SM, Wexner SD, Binderow SR, et al. Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods. Dis Colon Rectum 1994;37:689–696.
 
18. Young CJ, Simpson RR, King DW, et al. Oral sodium phosphate solution is a superior colonoscopy preparation to polyethylene glycol with bisacodyl. Dis Colon Rectum 2000;43:1568–1571.
 
19. Law WL, Choi HK, Chu KW, et al. Bowel preparation for colonoscopy: a randomized controlled trial comparing polyethylene glycol solution, one dose and two doses of oral sodium phosphate solution. Asian J Surg 2004;27:120–124.
 
20. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 Suppl 1:S62.
 
 
21. Lazarczyk DA, Stein AD, Courval JM, et al. Controlled study of cisapride-assisted lavage preparatory to colonoscopy. Gastrointest Endosc 1998;48:44–48.
 
22. Aronchick CA, Lipshutz WH, Wright SH, et al. A novel tableted purgative for colonoscopic preparation: efficacy and safety comparisons with Colyte and Fleet Phospho-Soda. Gastrointest Endosc 2000;52:346–352.
 
23. Froehlich F, Wietlisbach V, Gonvers JJ, et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc 2005;61:378–384.
 
24. Nelson DB, Barkun AN, Block KP, et al. Technology status evaluation report. Colonoscopy preparations. May 2001. Gastrointest Endosc 2001;54:829–832.
 
25. Toledo TK, DiPalma JA. Review article: colon cleansing preparation for gastrointestinal procedures [Review]. Aliment Pharmacol Ther 2001;15:605–611.
 
26. Golub RW, Kerner BA, Wise WE Jr. Colonoscopic preparations—which one? A blinded, prospective, randomized trial. Dis Colon Rectum 1995;38:594–599.
 
 
27. Marshall JB, Pineda JJ, Barthel JS, et al. Prospective, randomized trial comparing sodium phosphate solution with polyethylene glycol-electrolyte lavage for colonoscopy preparation. Gastrointest Endosc 1993;39:631–634.
 
28. DiPalma JA, Marshall JB. Comparison of a new sulfate-free polyethylene glycol electrolyte lavage solution versus a standard solution for colonoscopy cleansing. Gastrointest Endosc 1990;36:285–289.
 
29. Frommer D. Cleansing ability and tolerance of three bowel preparations for colonoscopy. Dis Colon Rectum 1997;40:100–104.
 
30. Anderson JC, Messina CR, Cohn W, et al. Factors predictive of difficult colonoscopy. Gastrointest Endosc 2001;54:558–562.
 
31. Cirocco WC, Rusin LC. Factors that predict incomplete colonoscopy. Dis Colon Rectum 1995;38:964–968.
 
32. Waye JD, Bashkoff E. Total colonoscopy: is it always possible? Gastrointest Endosc 1991;37:152–154.
 
33. Battle WM, Cohen JD, Snape WJ Jr. Disorders of colonic motility in patients with diabetes mellitus. Yale J Biol Med 1983;56:277–283.
 
34. The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT). Diabetologia 1998;41:416–423.
 
 
35. Ziegler D, Schadewaldt P, Pour Mirza A, et al. [13C] Octanoic acid breath test for non-invasive assessment of gastric emptying in diabetic patients: validation and relationship to gastric symptoms and cardiovascular autonomic function. Diabetologia 1996;39:823–830.
 
36. Iber FL, Parveen S, Vandrunen M, et al. Relation of symptoms to impaired stomach, small bowel, and colon motility in long-standing diabetes. Dig Dis Sci 1993;38:45–50.
 
37. Folwaczny C, Hundegger K, Volger C, et al. Measurement of transit disorders in different gastrointestinal segments of patients with diabetes mellitus in relation to duration and severity of the disease by use of the metal-detector test. Z Gastroenterol 1995;33:517–526.
 
38. Horowitz M, Harding PE, Maddox A, et al. Gastric and oesophageal emptying in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1989;32:151–159.
 
39. Asakawa H, Onishi M, Hayashi I, et al. Comparison between coefficient of R-R interval variation and gastric emptying in type 2 diabetes mellitus patients. J Gastroenterol Hepatol 2005;20:1358–1364.
 
40. Keshavarzian A, Iber FL, Vaeth J. Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroenterol 1987;82:29–35.
 
41. Hsu CW, Imperiale TF. Meta-analysis and cost comparison of polyethylene glycol lavage versus sodium phosphate for colonoscopy preparation. Gastrointest Endosc 1998;48:276–282.
 
42. Curran MP, Plosker GL. Oral sodium phosphate solution: a review of its use as a colorectal cleanser. Drugs 2004;64:1697–1714.
 
43. Lieberman DA, Ghormley J, Flora K. Effect of oral sodium phosphate colon preparation on serum electrolytes in patients with normal serum creatinine. Gastrointest Endosc 1996;43:467–469.
 
44. Unal S, Doğan UB, Oztürk Z, et al. A randomized prospective trial comparing 45 and 90-ml oral sodium phosphate with X-Prep in the preparation of patients for colonoscopy. Acta Gastroenterol Belg 1998;61:281–284.
 
45. Ozturk NA, Gokturk HS, Demir M, et al. The effect of autonomous neuropathy on bowel preparation in type 2 diabetes mellitus. Int J Colorectal Dis 2009;24:1407–1412.