Burden of Urological Complications in Men and Women With Long-standing Type 1 Diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Cohort

Hunter Wessells, Barbara H Braffett, Sarah K Holt, Alan M Jacobson, John W Kusek, Catherine Cowie, Rodney L Dunn, Aruna V Sarma, DCCT/EDIC Study Group, Hunter Wessells, Barbara H Braffett, Sarah K Holt, Alan M Jacobson, John W Kusek, Catherine Cowie, Rodney L Dunn, Aruna V Sarma, DCCT/EDIC Study Group

Abstract

Objective: Type 1 diabetes has been associated with high rates of urinary and sexual problems, but the cumulative burden and overlap of these complications are unknown. We sought to determine prevalence of urological complications in persons with type 1 diabetes, associations with clinical and diabetes-related factors, and rates of emergence, persistence, and remission.

Research design and methods: This 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) (652 women and 713 men) was conducted in 2003 and 2010/2011. Urinary incontinence (UI), lower urinary tract symptoms, urinary tract infection, female sexual dysfunction, erectile dysfunction, low male sexual desire, and orgasmic dysfunction were measured with validated instruments. Logistic regression determined association of complications with demographics and clinical characteristics.

Results: Of sexually active women completing the 2010/2011 survey, 35% reported no complications, 39% had one, 19% two, 5% three, and 2% four. In men, 31% had no complications, 36% had one, 22% two, 9% three, and 3% four. Sexual dysfunction was most prevalent (42% women and 45% men) followed by UI in women (31%) and low sexual desire in men (40%). Urological complications were associated with age, BMI, and HbA1c. Remission rates ranged from 4 to 12% over the 7-year interval between surveys.

Conclusions: Urological complications are prevalent and frequently co-occur in persons with type 1 diabetes. Remission rates in a minority subset indicate a rationale for future studies to mitigate the onset or impact of urological complications of diabetes.

Trial registration: ClinicalTrials.gov NCT00360815 NCT00360893.

© 2018 by the American Diabetes Association.

Figures

Figure 1
Figure 1
Study cohort diagram. Flow of participants through the study from DCCT to EDIC and UroEDIC I and II. There were a greater number of participants (1,224) in UroEDIC II compared with UroEDIC I (1,141). *Enrollees were asked to take part in UroEDIC II irrespective of participation in UroEDIC I. There was a net increase in participation from UroEDIC I to UroEDIC II.
Figure 2
Figure 2
A: Prevalence of urological complications in women at UroEDIC II. B: Prevalence of urological complications in men at UroEDIC II. Overlap of number of participants with specific complications and cumulative complication occurrence among women (A) and men (B) who completed UroEDIC II. In A, only women who were sexually active could be scored with the FSFI, reducing total number of participants included in the figure. Overlap of other complications was similar for women who were not sexually active (data not shown). Size of diagrams not proportional to number of participants with each complication. *FSD excluded in complication count. †Respondents had data available for all four complications.

References

    1. Centers for Disease Control and Prevention National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA, U.S. Department of Health and Human Services, 2014
    1. Brown JS, Wessells H, Chancellor MB, et al. . Urologic complications of diabetes. Diabetes Care 2005;28:177–185
    1. Kupelian V, Rosen RC, Link CL, et al. . Association of urological symptoms and chronic illness in men and women: contributions of symptom severity and duration--results from the BACH Survey. J Urol 2009;181:694–700
    1. Van Den Eeden SK, Sarma AV, Rutledge BN, et al. .; Diabetes Control and Complications Trial/Epidemiology of Diabetes Research Group . Effect of intensive glycemic control and diabetes complications on lower urinary tract symptoms in men with type 1 diabetes: Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. Diabetes Care 2009;32:664–670
    1. Czaja CA, Rutledge BN, Cleary PA, Chan K, Stapleton AE, Stamm WE; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group . Urinary tract infections in women with type 1 diabetes mellitus: survey of female participants in the Epidemiology of Diabetes Interventions and Complications study cohort. J Urol 2009;181:1129–1134; discussion 1134–1135
    1. Sarma AV, Kanaya A, Nyberg LM, et al. .; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group . Risk factors for urinary incontinence among women with type 1 diabetes: findings from the Epidemiology of Diabetes Interventions and Complications study. Urology 2009;73:1203–1209
    1. Wessells H, Penson DF, Cleary P, et al. .; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group . Effect of intensive glycemic therapy on erectile function in men with type 1 diabetes. J Urol 2011;185:1828–1834
    1. Dimitropoulos K, Bargiota A, Mouzas O, Melekos M, Tzortzis V, Koukoulis G. Sexual functioning and distress among premenopausal women with uncomplicated type 1 diabetes. J Sex Med 2012;9:1374–1381
    1. Enzlin P, Rosen R, Wiegel M, et al. .; DCCT/EDIC Research Group . Sexual dysfunction in women with type 1 diabetes: long-term findings from the DCCT/EDIC study cohort. Diabetes Care 2009;32:780–785
    1. Nathan DM, Genuth S, Lachin J, et al. .; Diabetes Control and Complications Trial Research Group . 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;329:977–986
    1. 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;22:99–111
    1. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49:822–830
    1. Sandvik H, Seim A, Vanvik A, Hunskaar S. A severity index for epidemiological surveys of female urinary incontinence: comparison with 48-hour pad-weighing tests. Neurourol Urodyn 2000;19:137–145
    1. Barry MJ, Fowler FJ Jr., O’Leary MP, et al. .; Measurement Committee of the American Urological Association . The American Urological Association symptom index for benign prostatic hyperplasia. J Urol 1992;148:1549–1557; discussion 1564
    1. Nathan DM, Cleary PA, Backlund JY, et al. .; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group . Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005;353:2643–2653
    1. Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care 1994;17:1281–1289
    1. Early Treatment Diabetic Retinopathy Study Research Group Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics. ETDRS report number 7. Ophthalmology 1991;98(5 Suppl.):741–756
    1. Kupelian V, Wei JT, O’Leary MP, et al. .; BACH Survery Investigators . Prevalence of lower urinary tract symptoms and effect on quality of life in a racially and ethnically diverse random sample: the Boston Area Community Health (BACH) Survey. Arch Intern Med 2006;166:2381–2387
    1. Rohrmann S, Smit E, Giovannucci E, Platz EA. Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III). Int J Obes 2005;29:310–316
    1. Kupelian V, Araujo AB, Chiu GR, Rosen RC, McKinlay JB. Relative contributions of modifiable risk factors to erectile dysfunction: results from the Boston Area Community Health (BACH) Survey. Prev Med 2010;50:19–25
    1. Minassian VA, Stewart WF, Wood GC. Urinary incontinence in women: variation in prevalence estimates and risk factors. Obstet Gynecol 2008;111:324–331
    1. Litman HJ, McKinlay JB. The future magnitude of urological symptoms in the USA: projections using the Boston Area Community Health survey. BJU Int 2007;100:820–825
    1. Jacobson AM, Braffett BH, Cleary PA, Gubitosi-Klug RA, Larkin ME; DCCT/EDIC Research Group . The long-term effects of type 1 diabetes treatment and complications on health-related quality of life: a 23-year follow-up of the Diabetes Control and Complications/Epidemiology of Diabetes Interventions and Complications cohort. Diabetes Care 2013;36:3131–3138
    1. Jacobson AM, Braffett BH, Cleary PA, et al. .; DCCT/EDIC Research Group . Relationship of urologic complications with health-related quality of life and perceived value of health in men and women with type 1 diabetes: the Diabetes Control and Complications Trial/Epidemiology of Interventions and Complications (DCCT/EDIC) cohort. Diabetes Care 2015;38:1904–1912
    1. Lutfey KE, Link CL, Rosen RC, Wiegel M, McKinlay JB. Prevalence and correlates of sexual activity and function in women: results from the Boston Area Community Health (BACH) Survey. Arch Sex Behav 2009;38:514–527
    1. Tennstedt SL, Link CL, Steers WD, McKinlay JB. Prevalence of and risk factors for urine leakage in a racially and ethnically diverse population of adults: the Boston Area Community Health (BACH) Survey. Am J Epidemiol 2008;167:390–399
    1. Nygaard I, Barber MD, Burgio KL, et al. .; Pelvic Floor Disorders Network . Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008;300:1311–1316
    1. Jackson SL, Scholes D, Boyko EJ, Abraham L, Fihn SD. Urinary incontinence and diabetes in postmenopausal women. Diabetes Care 2005;28:1730–1738
    1. Phelan S, Kanaya AM, Subak LL, et al. .; Look AHEAD Research Group . Weight loss prevents urinary incontinence in women with type 2 diabetes: results from the Look AHEAD trial. J Urol 2012;187:939–944
    1. Brown JS, Grady D, Ouslander JG, Herzog AR, Varner RE, Posner SF; Heart & Estrogen/Progestin Replacement Study (HERS) Research Group . Prevalence of urinary incontinence and associated risk factors in postmenopausal women. Obstet Gynecol 1999;94:66–70
    1. Lenherr SM, Clemens JQ, Braffett BH, et al. .; DCCT/EDIC Research Group . Glycemic control and urinary tract infections in women with type 1 diabetes: results from the DCCT/EDIC. J Urol 2016;196:1129–1135
    1. Saigal CS, Wessells H, Pace J, Schonlau M, Wilt TJ; Urologic Diseases in America Project . Predictors and prevalence of erectile dysfunction in a racially diverse population. Arch Intern Med 2006;166:207–212
    1. Gacci M, Corona G, Vignozzi L, et al. . Metabolic syndrome and benign prostatic enlargement: a systematic review and meta-analysis. BJU Int 2015;115:24–31
    1. Bavendam TG, Norton JM, Kirkali Z, et al. . Advancing a comprehensive approach to the study of lower urinary tract symptoms. J Urol 2016;196:1342–1349
    1. Subak LL, Johnson C, Whitcomb E, Boban D, Saxton J, Brown JS. Does weight loss improve incontinence in moderately obese women? Int Urogynecol J Pelvic Floor Dysfunct 2002;13:40–43
    1. Brown JS, Wing R, Barrett-Connor E, et al. .; Diabetes Prevention Program Research Group . Lifestyle intervention is associated with lower prevalence of urinary incontinence: the Diabetes Prevention Program. Diabetes Care 2006;29:385–390
    1. Breyer BN, Phelan S, Hogan PE, et al. .; Look AHEAD Research Group . Intensive lifestyle intervention reduces urinary incontinence in overweight/obese men with type 2 diabetes: results from the Look AHEAD trial. J Urol 2014;192:144–149
    1. Phelan S, Kanaya AM, Ma Y, et al. .; Diabetes Prevention Program Research Group . Long-term prevalence and predictors of urinary incontinence among women in the Diabetes Prevention Program Outcomes Study. Int J Urol 2015;22:206–212
    1. Travison TG, Shabsigh R, Araujo AB, Kupelian V, O’Donnell AB, McKinlay JB. The natural progression and remission of erectile dysfunction: results from the Massachusetts Male Aging Study. J Urol 2007;177:241–246; discussion 246
    1. Martin SA, Atlantis E, Lange K, Taylor AW, O’Loughlin P, Wittert GA; Florey Adelaide Male Ageing Study . Predictors of sexual dysfunction incidence and remission in men. J Sex Med 2014;11:1136–1147

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться