# Predicting hypoglycemia risk after gastrointestinal surgery in type 2 diabetes mellitus: a retrospective cohort study

## TL;DR

This study identifies risk factors for hypoglycemia in type 2 diabetes patients after gastrointestinal surgery and builds a predictive model to help manage their care.

## Contribution

A novel predictive model for hypoglycemia risk in T2DM patients after gastrointestinal surgery, validated for strong performance and clinical utility.

## Key findings

- A predictive model with an AUC of 0.837 was developed to assess hypoglycemia risk in T2DM patients after surgery.
- Five key predictors were identified, including diabetes duration, operation duration, and glucose fluctuation on the day of surgery.
- The model showed good calibration and strong clinical utility for risk stratification and decision-making.

## Abstract

To identify factors influencing hypoglycemia in patients with type 2 diabetes mellitus (T2DM) following gastrointestinal tumor surgery and construct a predictive model for assessing hypoglycemia risk.

We retrospectively collected data on 1280 patients with T2DM who underwent gastrointestinal tumor surgery and divided them into two groups—one for model building (n = 982) and another for validation (n = 298). We used multivariate logistic regression to develop a predictive model for hypoglycemia following gastrointestinal tumor surgery. The model’s predictive performance was evaluated using the area under the receiver operating characteristic (ROC) curve, and its generalization ability was evaluated using the bootstrap test and the five-fold cross-validation test.

We identified hypoglycemia following gastrointestinal tumor surgery in 124 of 982 (12.6%) T2DM patients in the developmental cohort. Finally, five predictors, including duration of diabetes, operation duration, preoperative fasting time, preoperative hypoglycemic regimen (subcutaneous insulin injection), and glucose fluctuation on the day of surgery, were integrated into the predictive model. The performance of the hypoglycemia risk prediction model for patients with T2DM undergoing gastrointestinal tumor surgery was comprehensively evaluated. The model demonstrated an area under the ROC curve (AUC) of 0.837 (95% CI: 0.792–0.882), indicating a strong discriminative ability. Internal validation via five-fold cross-validation with bootstrap resampling revealed close approximation of the calibration curve to the ideal line, refining high consistency between predicted probabilities and actual hypoglycemia occurrence. Decision curve analysis (DCA) further supported its clinical utility, indicating value in clinical decision making for hypoglycemia risk stratification and preventive intervention selection.

The developed model exhibits high discriminative ability and good calibration. Following visualization (e.g., nomogram), it provides a clinical tool for healthcare providers to stratify hypoglycemia risk in T2DM patients undergoing gastrointestinal tumor surgery, enabling personalized perioperative glucose management and informed decision making to improve patient outcomes.