Urological Complications Prevalent in Men and Women With Type 1 Diabetes

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The most prevalent complication was sexual dysfunction reported by both women and men, followed by urinary incontinence in women and low sexual desire in men.
The most prevalent complication was sexual dysfunction reported by both women and men, followed by urinary incontinence in women and low sexual desire in men.

The emergence and persistence of urological complications are associated with specific diabetes-related characteristics in patients with long-standing type 1 diabetes, according to a study published in the Diabetes Care.

The study included 652 women and 713 men who participated in the Diabetes Control and Complications Trial and the observational follow-up study, Epidemiology of Diabetes Interventions and Complications. The study cohort completed a self-administered series of well-validated questionnaires on sexual and urinary function, symptom impact, and urological history in 2003 and in 2010/2011. Outcome measures described the prevalence and co-occurrence of urinary incontinence, lower urinary tract symptoms, urinary tract infection, female sexual dysfunction, erectile dysfunction, low male sexual desire, and orgasmic dysfunction. The researchers used logistic regression models to analyze any association between complications and diabetes-related clinical and demographic characteristics.

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A total of 508 women completed both surveys: of sexually active participants, 35% had no complications, 39% reported a single complication, and 26% reported 2 or more complications.  A total of 551 men completed both surveys: 31% had no complications, 36% reported a single complication, and 33% reported 2 or more complications. The most prevalent complication was sexual dysfunction reported by both women and men, followed by urinary incontinence in women and low sexual desire in men.

Most of the participants who reported a complication in the first survey reported persistence of the same complication (56% to 86%) in the second survey, 7 years later. In men, emergence of lower-urinary tract symptoms was associated with age, as was the persistence of the 4 complications relating to male sexual dysfunction; persistence of erectile dysfunction and orgasmic dysfunction were associated with blood glucose (HbA1c).

In women, both the emergence of lower urinary tract symptoms and persistence of urinary incontinence were associated with age and HBA1c; emergence and persistence of female sexual dysfunction was associated with mostly with age. In addition, women who reported HbA1c >8.4% were 2 times more likely to report lower urinary tract symptoms and participants with a body mass index ≥ 30 kg/m2 was associated with increased odds of reporting urinary incontinence.  Remission rates reported for the study cohort ranged from 4% to 12% in the 7-year period between surveys.

Limitations of the study included the use of questionnaires to define urological complications, missing data from nonparticipation, and use of invalidated questions on urinary tract infection. Impact of treatment on complications was not accessible to the study investigators. Because the study cohort represented a select group that was highly motivated, findings may not be generalizable to the greater population.

Urological complications were prevalent in patients with type 1 diabetes, and most participants showed persistent urological complications over a 7-year period. An association found between diabetes-related factors and urological complications indicate overlapping mechanisms. Remission rates indicate a rational for future studies to mitigate the impact of urological complications in this population.

This study was supported by grant 5R01-DK-083927. Please refer to reference for a complete list of authors' disclosures.

Reference                                                                                                                       

Wessells H, Braffett BH, Holt SK, et al. Burden of urological complications in men and women with long-standing type 1 diabetes in the diabetes control and complication trial/epidemiology of diabetes interventions and complications cohort [published online August 13, 2018]. Diabetes Care. doi: 10.2337/dc18-0255

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