Tuesday, February 7, 2023
This article is intended for diabetologists/endocrinologists, family medicine/primary care practitioners, internists, nurses, pharmacists, nephrologists, family medicine practitioners, obstetricians/gynecologists/women's health practitioners, urologists, and other members of the healthcare team who treat and manage patients with type 1 diabetes.
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Persons with type 1 diabetes are known to have high rates of associated urinary and sexual conditions, such as sexual dysfunction, urinary tract infection (UTI), poor bladder emptying, urinary incontinence (UI), and other lower urinary tract symptoms (LUTS) that often result in care seeking and reduce quality of life. However, the cumulative burden and overlap of these complications have not previously been determined.
Urologic EDIC (UroEDIC) was an ancillary longitudinal study among participants in the Diabetes Control and Complications Trial (DCCT) and observational follow-up study Epidemiology of Diabetes Interventions and Complications (EDIC). The goals of UroEDIC were to examine prevalence of urological complications in persons with type 1 diabetes, associations with clinical and diabetes-related factors, and rates of emergence, persistence, and remission. These data could inform healthcare providers, patients, and families about traditionally embarrassing urological health problems and could facilitate development of risk factor models for specific urologic complications among persons with type 1 diabetes.
Urologic complications are present in about two thirds of adults with long-duration type 1 diabetes, new research suggests.
The findings, from an ancillary study to the EDIC study, the observational follow-up to the landmark DCCT, were published online August 13 in Diabetes Care.
"Urological complications are prevalent and frequently coexist in men and women with type 1 diabetes," write Hunter B. Wessells, MD, from the Department of Urology and Diabetes Research Center, University of Washington, Seattle, and colleagues. "[A]s improvements in diabetes management reduce the severity of retinopathy, nephropathy, and neuropathy, urological complications may become important drivers of quality of life."
The DCCT, which proved the benefits of tight glycemic control in reducing microvascular complications in type 1 diabetes, ended early in 1993 after a mean follow-up of 6.5 years. In 1994, 96% of the original 1441 participants transitioned into EDIC, at which point they had a mean age of 33.6 years and mean diabetes duration of 12.2 years.
All were invited to participate in the ancillary UroEDIC study, which involved a series of well-validated self-administered urologic symptom questionnaires. A total of 508 women and 551 men completed the surveys at 2 points: UroEDIC I in 2003 and UroEDIC II in 2010 to 2011.
Overall, 65% of women and 68% of men reported at least 1 urologic complication at UroEDIC II. Among the women, 22% reported lower urinary tract symptoms, 42% sexual dysfunction, 31% urinary incontinence, and 17% urinary tract infection.
Among the men, 24% reported lower urinary tract symptoms, 45% erectile dysfunction, 40% low sexual desire, and 14% orgasmic dysfunction.
Among sexually active women, 35% reported no urologic complications, 39% had 1, and 26% had 2 or more other complications. Lower urinary tract symptoms commonly co-occurred with other urologic complications, whereas female sexual dysfunction occurred more often in isolation.
In the men, 31% reported no urologic complications, 36% had 1, and 33% had 2 or more. Here, lower urinary tract symptoms occurred more commonly in isolation, whereas erectile dysfunction, low sexual desire, and orgasmic dysfunction tended to co-occur.
Higher hemoglobin A1c levels were associated with increased risk for urologic complications in both women and men. For women, the risk for lower urinary tract symptoms among those in the highest hemoglobin A1c quartile (>8.54%) was more than twice as high as among those in the lowest quartile (≤7.38%). For the men, those in higher HbA1c quartiles had higher odds for both erectile dysfunction and orgasmic dysfunction.
A body mass index of 30 kg/m2 or higher was associated with a greater risk for urinary incontinence in women, but not with urologic complications among the men. Diabetic neuropathic and microvascular complications were also associated with urologic complications in both men and women.
The EDIC studies are funded by the National Institutes of Health. The authors have disclosed no relevant financial relationships.
Diabetes Care. Published online August 13, 2018.[1]
