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

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.