Meta-analysis of the significance of asymptomatic bacteriuria in diabetes

Marjo Renko, Päivi Tapanainen, Päivi Tossavainen, Tytti Pokka, Matti Uhari, Marjo Renko, Päivi Tapanainen, Päivi Tossavainen, Tytti Pokka, Matti Uhari

Abstract

Objective: To evaluate whether asymptomatic bacteriuria (ASB) is more common in patients with diabetes than among control subjects. In addition, we wanted to clarify the clinical significance of ASB in patients with diabetes.

Research design and methods: We conducted a systematic review and meta-analysis of published data since 1966. Twenty-two studies fulfilled the inclusion criteria of the meta-analysis.

Results: ASB was present in 439 of 3,579 (12.2%) patients with diabetes and in 121 of 2,702 (4.5%) healthy control subjects. ASB was more common both in patients with type 1 diabetes (odds ratio 3.0 [95% CI 1.1-8.0]) and type 2 diabetes (3.2 [2.0-5.2]) than in control subjects. The point prevalence of ASB was higher in both women (14.2 vs. 5.1%; 2.6 [1.6-4.1]) and men (2.3 vs. 0.8%; 3.7 [1.3-10.2]) as well as in children and adolescents (12.9 vs. 2.7%; 5.4 [2.7-11.0]) with diabetes than in healthy control subjects. Albuminuria was more common in patients with diabetes and ASB than those without ASB (2.9 [1.7-4.8]). History of urinary tract infections was associated with ASB (1.6 [1.1-2.3]).

Conclusions: We were able to show that the prevalence of ASB is higher in all patients with diabetes compared with control subjects. We also found that diabetic subjects with ASB more often had albuminuria and symptomatic urinary tract infections.

Figures

Figure 1
Figure 1
Flowchart of the literature search.
Figure 2
Figure 2
Forest plot of 12 studies on the prevalence of ASB in women with diabetes and healthy control subjects. Because of the heterogeneity of the studies (I2 63%, P < 0.001), the results of the random-effects model are presented.
Figure 3
Figure 3
Forest plot of five studies on the prevalence of ASB in men with diabetes and healthy control subjects. Because the heterogeneity test was not significant (I2 25.6%, P = 0.24) the results of the fixed-effects model are presented.
Figure 4
Figure 4
Forest plot of two studies on the prevalence of ASB in children and adolescents with diabetes and healthy control subjects. Because the heterogeneity test was not significant (I2, *P = 0.51) the results of the fixed-effects model are presented.
Figure 5
Figure 5
Forest plot of three studies on albuminuria in patients with diabetes with and without ASB. Because the heterogeneity test was not significant (I2 0%, P = 0.96) the results of the fixed-effects model are presented.

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