Development and validation of a hypoglycemia risk prediction model for hospitalized type 2 diabetes patients following laparoscopic colorectal cancer resection: a retrospective cohort study

Vollständiger Abstract

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Objective To identify factors associated with postoperative hypoglycemia among inpatients with type 2 diabetes mellitus (T2DM) receiving laparoscopic colorectal cancer (CRC) resection, and to construct a predictive model for assessing hypoglycemia risk. Methods This retrospective cohort study collected data on hospitalized T2DM patients who underwent laparoscopic CRC resection between January 2021 and June 2023, and randomized them into a training and an internal validation cohorts in a 7:3 ratio. Multivariate logistic regression was used to build a prediction model for in-hospital hypoglycemia after laparoscopic CRC resection and identify independent predictors for level 1 and level 2 hypoglycemia. Results Among 720 hospitalized T2DM patients receiving laparoscopic CRC resection, the overall incidence of postoperative hypoglycemia was 16.7% (120 patients), including 98 level 1 cases and 22 level 2 cases. A multivariable predictive model was developed using five independent predictors: long T2DM duration, low preoperative day-1 fasting plasma glucose (FPG), American Society of Anes- thesiologists physical status grade > II, prolonged postoperative fasting, and prior long-term insulin therapy. The model yielded an area under the receiver operating characteristic curve (AUC) of 0.817 (95% confidence interval [CI], 0.774-0.859) in the training cohort and 0.751 (95% CI, 0.669-0.833) in the validation cohort for hypoglycemia prediction. Level 1 postoperative hypoglycemia was independently predicted by long T2DM duration, low preoperative day-1 FPG, and prolonged postoperative fasting; while level 2 hypoglycemia was associated with low body mass index (BMI), low pre- operative day-1 FPG, and elevated neutrophil (NEUT) proportion on postoperative day 3. Conclusions The nomogram prediction model constructed in this study provided reliable risk estimation for postoperative hypoglycemia in hospitalized patients with T2DM undergoing laparoscopic CRC resection, and might serve as a practical adjunct to inform individualized clinical decisions and optimize perioperative glycemic management.