International Urology and Nephrology

, Volume 46, Issue 7, pp 1269–1275 | Cite as

Prevalence and associated risk factors of nocturia and subsequent mortality in 1,301 patients with type 2 diabetes

  • Min-Shen Chung
  • Yao-Chi Chuang
  • Jong-Jer Lee
  • Wei-Chia Lee
  • Michael B. Chancellor
  • Rue-Tsuan LiuEmail author
Urology - Original Paper



To evaluate the correlates of nocturia and subsequent mortality in patients with type 2 diabetes mellitus (T2DM).


A self-administered questionnaire containing overactive bladder symptom score was obtained from subjects with T2DM. Nocturia and severe nocturia were defined as rising ≥2 or ≥3 per night to void, respectively. Patient characteristics and diabetes-related complications to risk of nocturia were evaluated.


Of 1,301 consecutive subjects, 59.6 and 25.3 % reported having nocturia and severe nocturia, respectively. The presence and severity of nocturia increased with age and overactive bladder (OAB). The presence of OAB was 28.8 % in patients with nocturia and was significantly associated with nocturia (OR 2.26) after adjustment for age and duration of DM. The presence of stroke, calcium channel blocker use, hypertension, waist circumference greater than standard, albuminuria, and higher serum creatinine level, and high-sensitivity C-reactive protein was associated with nocturia and severe nocturia after adjustment for age, duration of DM, and the presence of OAB. Higher estimated glomerular filtration rate, hemoglobin, serum albumin, and male gender were less likely to have nocturia (OR <1). Severe nocturia increased mortality (OR 1.93) independent of age and DM duration and has a higher mortality rate compared to those without severe nocturia (6.1 vs. 2.4 %, P = 0.001) in 2.5 years follow-up.


While OAB is an important predictor of nocturia in T2DM patients, systemic issues, including stroke, hypertension, obesity, and chronic kidney disease, have further impact on nocturia independent of OAB. Severe nocturia is a marker for increased mortality.


Nocturia Diabetes Overactive bladder 



Authors received funding support from CMRPG 860381.

Conflict of interest

Authors have no conflict of interests to declare.


  1. 1.
    van Kerrebroeck P, Abrams P, Chaikin D et al (2002) The standardisation of terminology in nocturia: report from the standardisation sub-committee of the international continence society. Neurourol Urodynam 21:179–183CrossRefGoogle Scholar
  2. 2.
    van Dijk L, Kooij DG, Schellevis FG (2002) Nocturia in the Dutch adult population. BJU Int 90:644–648PubMedCrossRefGoogle Scholar
  3. 3.
    Fitzgerald MP, Litman HJ, Link CL, McKinlay JB (2007) The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey. J Urol 177:1385–1389PubMedCrossRefGoogle Scholar
  4. 4.
    Ruud Bosch JLH, Weiss JP (2010) The prevalence and causes of nocturia. J Urol 184:440–446CrossRefGoogle Scholar
  5. 5.
    Irwin DE, Milsom I, Hunskaar S et al (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50:1306–1315PubMedCrossRefGoogle Scholar
  6. 6.
    Liu RT, Chung MS, Lee WC et al (2011) Prevalence of overactive bladder (OAB) and associated risk factors in 1,359 patients with type 2 diabetes. Urology 78:1040–1045PubMedCrossRefGoogle Scholar
  7. 7.
    Gulur DM, Mevcha AM, Drake MJ (2011) Nocturia as a manifestation of systemic disease. BJU Int 107:702–713PubMedCrossRefGoogle Scholar
  8. 8.
    Yoshimura K (2012) Correlates for nocturia: a review of epidemiological studies. Int J Urol 19:317–329PubMedCrossRefGoogle Scholar
  9. 9.
    Yamaguchi C, Sakakibara R, Uchiyama T et al (2007) Overactive bladder in diabetes: a peripheral or central mechanism? Neurourol Urodynam 26:807–813CrossRefGoogle Scholar
  10. 10.
    Yoshimura N, Chancellor MB, Andersson KE et al (2005) Recent advances in understanding the biology of diabetes-associated bladder complications and novel therapy. BJU Int 95:733–738PubMedCrossRefGoogle Scholar
  11. 11.
    Homma Y, Yoshida M, Seki N et al (2006) Symptom assessment tool for overactive bladder syndrome: overactive bladder symptom score. Urology 68:318–323PubMedCrossRefGoogle Scholar
  12. 12.
    Liew LC, Tiong HY, Wong ML et al (2006) A population study of nocturia in Singapore. BJU Int 97:109–112PubMedCrossRefGoogle Scholar
  13. 13.
    Tibaek S, Gard G, Klarskov P et al (2008) Prevalence of lower urinary tract symptoms (LUTS) in stroke patients: a cross-sectional, clinical survey. Neurourol Urodyn 27:763–771PubMedCrossRefGoogle Scholar
  14. 14.
    Hsu CY, Iribarren C, McCulloch CE et al (2009) Risk factors for end-stage renal disease: 25-year follow-up. Arch Intern Med 169:342–350PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Calhoun DA, Harding SM (2010) Sleep and hypertension. Chest 138:434–443PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Subak LL, Whitcomb E, Shen H et al (2005) Weight loss: a novel and effective treatment for urinary incontinence. J Urol 174:190–195PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Tai HC, Chung SD, Ho CH et al (2010) Metabolic syndrome components worsen lower urinary tract symptoms in women with type 2 diabetes. J Clin Endocrinol Metab 95:1143–1150PubMedCrossRefGoogle Scholar
  18. 18.
    Wu MY, Wu YL, Hsu YH, Lin YF, Fan YC, Lin YC, Chang SJ (2012) Risks of nocturia in patients with chronic kidney disease- doe the metabolic syndrome and its components matter? J Urol 188:2269–2273PubMedCrossRefGoogle Scholar
  19. 19.
    Kupelian V, McVary KT, Barry MJ et al (2009) Association of C-reactive protein and lower urinary tract symptoms in men and women: results from Bostonarea community health survey. Urology 73:950–957PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Lu Z, Gao Y, Tan A et al (2012) Increased high-sensitivity C-reactive protein predicts a high risk of lower urinary tract symptoms in Chinese male: results from the Fangchenggang Area Male Health and Examination Survey. Prostate 72:193–200PubMedCrossRefGoogle Scholar
  21. 21.
    van Doorn B, Kok ET, Blanker MH et al (2012) Mortality in older men with nocturia. A 15-year followup of the Krimpen study. J Urol 187:1727–1731PubMedCrossRefGoogle Scholar
  22. 22.
    Kupelian V, Fitzgerald MP, Kaplan SA et al (2011) Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol 185:571–577PubMedCrossRefGoogle Scholar
  23. 23.
    Asplund R (1999) Mortality in the elderly in relation to nocturnal micturition. BJU Int 84:297–301PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Min-Shen Chung
    • 1
  • Yao-Chi Chuang
    • 3
  • Jong-Jer Lee
    • 2
  • Wei-Chia Lee
    • 3
  • Michael B. Chancellor
    • 4
  • Rue-Tsuan Liu
    • 1
    Email author
  1. 1.Division of Metabolism, Chang Gung Memorial Hospital, Kaohsiung Medical CenterChang Gung University College of MedicineKaohsiungTaiwan
  2. 2.Department of Ophthalmology, Kaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwan
  3. 3.Division of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical CenterChang Gung University College of MedicineKaohsiungTaiwan
  4. 4.Department of UrologyWilliam Beaumont HospitalRoyal OakUSA

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