Risk Factors for Urinary Incontinence Among Women with Type 1 Diabetes: Findings from the Epidemiology of Diabetes Interventions and Complications Study

Overview

Journal Urology

Specialty Urology

Date 2009 Apr 14

PMID 19362350

Citations 17

Authors

Aruna V Sarma

Alka Kanaya

Leroy M Nyberg

John W Kusek

Eric Vittinghoff

Brandy Rutledge

Patricia A Cleary

Patricia Gatcomb

Jeanette S Brown

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine risk factors for, and long-term effects of, glycemic control on urinary incontinence among women with type 1 diabetes enrolled in the Epidemiology of Diabetes Interventions and Complications study.

Methods: The Diabetes Control and Complications Trial (1982-1993) cohort follow-up, Epidemiology of Diabetes Interventions and Complications trial, began in 1994. In 2004, the female participants (n = 550) completed a self-administered questionnaire on incontinence. Our primary outcome was weekly or greater incontinence, overall and by type. Multivariate regression models were used to determine independent predictors of weekly urinary incontinence, both overall and by type.

Results: Overall, 38% of women reported any incontinence and 17% reported weekly or greater incontinence. An increasing body mass index (odds ratio 1.1, 95% confidence interval 1.1-1.2) was significantly associated with weekly incontinence, overall and by type. Advancing age and >/=2 urinary tract infections in the previous year were associated with weekly urge incontinence (odds ratio 1.4, 95% confidence interval 1.0-2.0 per 5 years, and odds ratio 4.9, 95% confidence interval 1.8-13.5, respectively). Weaker evidence was seen for increased risk with age for overall weekly incontinence (22% per 5 years, P = .06) and stress incontinence (21% per 5 years, P = .08).

Conclusions: Urinary incontinence is common among women with type 1 diabetes and the risk factors, including advancing age, increased weight, and previous urinary tract infection, are important. Weight reduction and the treatment of urinary tract infections might have the additional benefit of preventing incontinence or reducing its severity.

Citing Articles

Male Akita diabetic mice develop underactive bladder independent of NLRP3 that can be prevented with blood glucose control.

Livingston A, Purves J, Odom M, Jin H, Hughes Jr F Continence (Amst). 2024; 12.

PMID: 39399064 PMC: 11466384. DOI: 10.1016/j.cont.2024.101690.

Urologic complications in diabetes.

Blair Y, Wessells H, Pop-Busui R, Ang L, Sarma A J Diabetes Complications. 2022; 36(10):108288.

PMID: 36088680 PMC: 10783766. DOI: 10.1016/j.jdiacomp.2022.108288.

Diabetic bladder dysfunction progresses from an overactive to an underactive phenotype in a type-1 diabetic mouse model (Akita female mouse) and is dependent on NLRP3.

Hughes Jr F, Allkanjari A, Odom M, Jin H, Purves J Life Sci. 2022; 299:120528.

PMID: 35381220 PMC: 9112812. DOI: 10.1016/j.lfs.2022.120528.

Regenerative potential of human dental pulp stem cells in the treatment of stress urinary incontinence: In vitro and in vivo study.

Zordani A, Pisciotta A, Bertoni L, Bertani G, Vallarola A, Giuliani D Cell Prolif. 2019; 52(6):e12675.

PMID: 31553127 PMC: 6868931. DOI: 10.1111/cpr.12675.

NLRP3 Promotes Diabetic Bladder Dysfunction and Changes in Symptom-Specific Bladder Innervation.

Hughes Jr F, Hirshman N, Inouye B, Jin H, Stanton E, Yun C Diabetes. 2018; 68(2):430-440.

PMID: 30425063 PMC: 6341307. DOI: 10.2337/db18-0845.

References

Subak L, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown J . Weight loss: a novel and effective treatment for urinary incontinence. J Urol. 2005; 174(1):190-5. PMC: 1557356. DOI: 10.1097/01.ju.0000162056.30326.83. View

Cleary P, Orchard T, Genuth S, Wong N, Detrano R, Backlund J . The effect of intensive glycemic treatment on coronary artery calcification in type 1 diabetic participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study. Diabetes. 2006; 55(12):3556-65. PMC: 2701297. DOI: 10.2337/db06-0653. View

Ishigooka M, Suzuki Y, Hayami S, Ichiyanagi O, Hashimoto T, Nakada T . Role of symptom scoring and uroflowmetry in patients with diabetic cystopathy. Int Urol Nephrol. 1996; 28(6):761-6. DOI: 10.1007/BF02550724. View

Ingberg C, Palmer M, Schvarcz E, Aman J . Prevalence of urinary tract symptoms in long-standing type 1 diabetes mellitus. Diabetes Metab. 1998; 24(4):351-4. View

Brown J, Wessells H, Chancellor M, Howards S, Stamm W, Stapleton A . Urologic complications of diabetes. Diabetes Care. 2004; 28(1):177-85. DOI: 10.2337/diacare.28.1.177. View

Brown J, Grady D, Ouslander J, Herzog A, Varner R, Posner S . Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Heart & Estrogen/Progestin Replacement Study (HERS) Research Group. Obstet Gynecol. 1999; 94(1):66-70. DOI: 10.1016/s0029-7844(99)00263-x. View

Brown J, Wing R, Barrett-Connor E, Nyberg L, Kusek J, Orchard T . Lifestyle intervention is associated with lower prevalence of urinary incontinence: the Diabetes Prevention Program. Diabetes Care. 2006; 29(2):385-90. PMC: 1557353. DOI: 10.2337/diacare.29.02.06.dc05-1781. View

Brown J, Vittinghoff E, Lin F, Nyberg L, Kusek J, Kanaya A . Prevalence and risk factors for urinary incontinence in women with type 2 diabetes and impaired fasting glucose: findings from the National Health and Nutrition Examination Survey (NHANES) 2001-2002. Diabetes Care. 2006; 29(6):1307-12. PMC: 1557358. DOI: 10.2337/dc05-2463. View

Grady D, Brown J, Vittinghoff E, APPLEGATE W, Varner E, Snyder T . Postmenopausal hormones and incontinence: the Heart and Estrogen/Progestin Replacement Study. Obstet Gynecol. 2001; 97(1):116-20. DOI: 10.1016/s0029-7844(00)01115-7. View

10.

Hannestad Y, Rortveit G, Sandvik H, Hunskaar S . A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trøndelag. J Clin Epidemiol. 2000; 53(11):1150-7. DOI: 10.1016/s0895-4356(00)00232-8. View

11.

Brown J, Vittinghoff E, Kanaya A, Agarwal S, Hulley S, Foxman B . Urinary tract infections in postmenopausal women: effect of hormone therapy and risk factors. Obstet Gynecol. 2002; 98(6):1045-52. DOI: 10.1016/s0029-7844(01)01630-1. View

12.

Jackson S, Scholes D, Boyko E, Abraham L, Fihn S . Urinary incontinence and diabetes in postmenopausal women. Diabetes Care. 2005; 28(7):1730-8. DOI: 10.2337/diacare.28.7.1730. View

13.

Steffes M, Cleary P, Goldstein D, Little R, Wiedmeyer H, Rohlfing C . Hemoglobin A1c measurements over nearly two decades: sustaining comparable values throughout the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complications study. Clin Chem. 2005; 51(4):753-8. PMC: 2635091. DOI: 10.1373/clinchem.2004.042143. View

14.

. Epidemiology of Diabetes Interventions and Complications (EDIC). Design, implementation, and preliminary results of a long-term follow-up of the Diabetes Control and Complications Trial cohort. Diabetes Care. 1999; 22(1):99-111. PMC: 2745938. DOI: 10.2337/diacare.22.1.99. View

15.

Danforth K, Townsend M, Lifford K, Curhan G, Resnick N, Grodstein F . Risk factors for urinary incontinence among middle-aged women. Am J Obstet Gynecol. 2006; 194(2):339-45. PMC: 1363686. DOI: 10.1016/j.ajog.2005.07.051. View

16.

Lifford K, Curhan G, Hu F, Barbieri R, Grodstein F . Type 2 diabetes mellitus and risk of developing urinary incontinence. J Am Geriatr Soc. 2005; 53(11):1851-7. DOI: 10.1111/j.1532-5415.2005.53565.x. View

17.

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

18.

Hunskaar S, Arnold E, Burgio K, Diokno A, Herzog A, Mallett V . Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2000; 11(5):301-19. DOI: 10.1007/s001920070021. View

19.

Yoshimura N, Chancellor M, Andersson K, Christ G . Recent advances in understanding the biology of diabetes-associated bladder complications and novel therapy. BJU Int. 2005; 95(6):733-8. DOI: 10.1111/j.1464-410X.2005.05392.x. View

20.

Genuth S . Insights from the diabetes control and complications trial/epidemiology of diabetes interventions and complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes. Endocr Pract. 2006; 12 Suppl 1:34-41. DOI: 10.4158/EP.12.S1.34. View