The effect of sodium phosphate on colon cleansi̇ng in patients with type 2 diabetes melli̇tus

Introduction: The need for colonoscopy is common among diabetic patients because of the high prevalence of gastrointestinal symptoms. Because the colonoscopy is the current Standard method for evaluation of the colon, the diagnostic accuracy of the colonoscopy depends on the quality of the colon cleansing. However, there are no Standard per se for bowel preperation for type 2 diabetics. Aim: in this study, we aimed to evaluate the efficacy, safety and tolerability of sodium phosphate administration for colon cleansing and also the effect of diabetic autonomous neuropathy on bowel preperation in type 2 diabetics. Material-Method: A total of 50 consecutive type 2 diabetics and 50 consecutive non-diabetic patients requiring outpatient colonoscopy underwent colonic cleansing by drinking divided-dose sodium phosphate 90 mi (Fleet Phospho Soda) before the procedure. Exclusion criteria were acute and chronic renal failure, chronic parenchymal liver disease, decompensated heart failure, coronary heart disease, intestinal obstraction, laxative ör prokinetic drug use in the previous 6 months and the age older than 65 years. The safety, efficacy and the tolerability of the sodium phosphate was evaluated in both groups. Ali patients undenvent a detailed cardiologic examination with blood pressure measurement on standing and sitting posisiton, electrocardiography, echocardiography and Holter 24 hours rhythm monitoring. Heart rate variability testing was performed with both time domain and the frequency domain methods. Results: Gender, age, blood pressure and heart rates did not differ significantly between the two groups (p>0,05). The mean duration of diabetes was 59+11,6 (6-360) months and the mean HbAlc level was 6,6±1,7 %. The mean Body Mass Index scores were 30,4+6,0kg/m2 and 27,6+5,2 kg/m2 respectively among type 2 diabetics ana non diabatic controls (p=0,01). The BMI of diabetic patients were higher than the controls and the difference betvveen the groups was statistically significant. Although the BMI of diabetic patients with adequate bowel cleansing were significantly lower than that of inaduaquate bowel cleansing, the difference betvveen the groups was not statistically significant (p=0,06). There was no significant difference in basal gastrointestinal complaints, indications for colonoscopy and defecation habits between the groups (p>0,05). Adequate colon cleansing was achieved in 94% and 70% respectively, in control patients and type 2 diabetics (p=0,002). The time required for cecal intubation, total procedural time and the colonoscopic findings were ali similar in both groups and no statistically significant relation was detected (p>0,05). The prevalence of orthostatic hypotension was bigher among diabetics as compared to control patients (p=0,008) and also the impairement of herat rate variability (p<0,05). Conclusion: These data suggest that, although the preperation with sodium phosphate is safe and tolerable in diabetics, it's not adequate overall and related to the duration of hyperglycemia and the presence of autonomous neuropathy. Sodium phosphate is tolerable, safe and cheaper way of colon cleansing in diabetics but for adequate cleansing the control of autonomous neuropathy, hyperglycemia and additional methods are required.