Bowel Preparation Before Colonoscopy Linked to Higher Hypoglycemia Risk in Children and Young Adults: Study
USA: A retrospective study published in The American Journal of Gastroenterology found that children and young adults undergoing bowel preparation for colonoscopy faced an increased risk of hypoglycemia. The findings highlight the need for careful glucose monitoring and preventive strategies during colonoscopy preparation in younger patients.
Colonoscopy preparation often requires prolonged fasting and bowel-cleansing regimens, which can place pediatric patients at risk for low blood sugar levels. While fasting-related hypoglycemia is known to occur more commonly in children than adults, limited data have been available regarding its frequency and associated risk factors during colonoscopy preparation. To address this gap, researchers led by Stephanie W. Hum evaluated the prevalence of hypoglycemia among children and young adults undergoing outpatient colonoscopy.
The investigators conducted a retrospective review of point-of-care glucose measurements obtained before colonoscopy procedures performed at the Children’s Hospital of Philadelphia between January 2020 and December 2024. The study included 5,129 colonoscopies in patients ranging from 5 months to 27 years of age.
Researchers analyzed the relationship between patient characteristics and the likelihood of hypoglycemia using Bayesian generalized linear mixed models. Hypoglycemia was assessed across multiple severity thresholds, including moderate and severe forms.
The study led to the following findings:
- Hypoglycemia was relatively common before colonoscopy among children and young adults undergoing bowel preparation.
- Overall, 8% of patients experienced low blood glucose levels before the procedure.
- Moderate hypoglycemia was observed in 3% of patients.
- Severe hypoglycemia occurred in 1% of patients.
- Younger age was identified as one of the strongest risk factors for hypoglycemia.
- Children younger than 3 years had a significantly higher risk of developing hypoglycemia compared to older children and young adults.
- Lower weight percentiles were consistently associated with an increased risk of hypoglycemia across all severity levels.
- Patients scheduled for afternoon colonoscopy procedures had a greater likelihood of hypoglycemia, potentially due to prolonged fasting durations.
- Feeding tube use, feeding difficulties, and procedure location were initially associated with hypoglycemia, but these associations were not significant after adjustment for other variables.
The findings highlight the need to identify high-risk pediatric patients during colonoscopy preparation, particularly younger children and those with lower body weight, who may require closer monitoring and individualized preparation strategies.
The researchers suggested that routine pre-procedure glucose screening, along with modified fasting protocols and improved nutritional support, could help reduce the risk of hypoglycemia. Despite its retrospective design, the large real-world dataset provides valuable evidence that may help shape safer colonoscopy preparation protocols for children and young adults.
Reference:
Hum, Stephanie W. MD1,a; Manfredi, Michael A. MD1,2; McWilliams, Tara MS3; Hodges, Ashley MD2,4; Mamula, Petar MD1,2; Weintraub, Ari Y. MD2,4. Increased risk of hypoglycemia in children and young adults after undergoing bowel preparation for colonoscopy. The American Journal of Gastroenterology ():10.14309/ajg.0000000000004065, May 26, 2026. | DOI: 10.14309/ajg.0000000000004065
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