Glycaemic control and risk of incident urinary incontinence in women with Type 1 diabetes: results from the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study

Abstract

Aims: To study the impact of glycaemic control on urinary incontinence in women who participated in the Diabetes Control and Complications Trial (DCCT; 1983-1993) and its observational follow-up study, the Epidemiology of Diabetes Interventions and Complications (EDIC; 1994-present).

Methods: Study participants were women who completed, at both years 10 (2003) and 17 (2010) of the EDIC follow-up, the urological assessment questionnaire (UroEDIC). Urinary incontinence was defined as self-reported involuntary leakage of urine that occurred at least weekly. Incident urinary incontinence was defined as weekly urinary incontinence present at EDIC year 17 but not at EDIC year 10. Multivariable regression models were used to examine the association of incident urinary incontinence with comorbid prevalent conditions and glycaemic control (mean HbA1c over the first 10 years of EDIC).

Results: A total of 64 (15.3%) women with Type 1 diabetes (mean age 43.6 ± 6.3 years at EDIC year 10) reported incident urinary incontinence at EDIC year 17. When adjusted for clinical covariates (including age, DCCT cohort assignment, DCCT treatment arm, BMI, insulin dosage, parity, hysterectomy, autonomic neuropathy and urinary tract infection in the last year), the mean EDIC HbA1c was associated with increased odds of incident urinary incontinence (odds ratio 1.03, 95% CI 1.01-1.06 per mmol/mol increase; odds ratio 1.41, 95% CI 1.07-1.89 per % HbA1c increase).

Conclusions: Incident urinary incontinence was associated with higher HbA1c levels in women with Type 1 diabetes, independent of other recognized risk factors. These results suggest the potential for women to modify their risk of urinary incontinence with improved glycaemic control. (Clinical Trials Registry no: NCT00360815 and NCT00360893).

© 2016 Diabetes UK.

Figures

FIGURE 1

Flow of participants in the DCCT/EDIC/UroEDIC study. DCCT, Diabetes Control and Complications Trial; EDIC, Epidemiology of Diabetes Interventions and Complications study; UroEDIC, EDIC substudy on urological complications; UI, urinary incontinence.

FIGURE 2

Multivariable adjusted odds ratios of incident weekly urinary incontinence (UI) at Epidemiology of Diabetes Interventions and Complications study (EDIC) year 17 by tertiles of HbA1c (EDIC mean HbA1c up to year 10 [HbA1c reference <58 mmol/mol or <7.38%)]. P value based on overall Wald chi-squared test for parameter estimate of HbA1c in the multivariable logistic regression model shown in Table 2. Odds of incident weekly UI at EDIC year 17 adjusted for the following EDIC year 10 characteristics: attained age; Diabetes Control and Complications Trial (DCCT) cohort assignment; DCCT treatment group; EDIC mean daily insulin dose; EDIC mean BMI; parity; hysterectomy; autonomic neuropathy; and urinary tract infection.