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Nocturia indicates a poor health status and increases mortality in male patients with type 2 diabetes mellitus

International Urology and Nephrology volume 48, pages 1209–1214 (2016)Cite this article

Abstract

Objectives

To investigate the association between nocturia and erectile dysfunction, androgen deficiency, overactive bladder and systemic diseases in men with type 2 diabetic mellitus.

Methods

A self-administered questionnaire containing overactive bladder symptom score and sexual health inventory for men was obtained from subjects with type 2 diabetic mellitus. 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.

Results

Of 632 consecutive subjects, 56.0 and 24.2 % reported having nocturia and severe nocturia, respectively. After adjustment of age, diabetic mellitus duration, and overactive bladder, the presence of erectile dysfunction, stroke, hypertension, and higher serum creatinine level was associated with nocturia and severe nocturia. The patients with the lowest quartile of testosterone level (2.21 ± 0.51 ng/mL) had higher prevalence of nocturia (65.1 %) and severe nocturia (32.9 %) than the sum of the other three quartiles. The patients with severe nocturia had threefold higher mortality than the other group after 3.5-year follow-up.

Conclusions

The presence of nocturia was associated with erectile dysfunction, systemic vascular events, higher mortality, and indicated poor health in male with type 2 diabetic mellitus.

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Fig. 1

Abbreviations

ED:

Erectile dysfunction

AD:

Androgen deficiency

OAB:

Overactive bladder

T2DM:

Type 2 diabetic mellitus

SHIM:

Sexual health inventory for men

CHD:

Coronary heart disease

OABSS:

Overactive bladder symptom score

BMI:

Body mass index

HbA1c:

Glycated hemoglobin

hsCRP:

High-sensitivity C-reactive protein

References

  1. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE (2014) Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 103:137–149

    CAS  Article  PubMed  Google Scholar 

  2. Chang C, Lu F, Yang YC, Wu JS, Wu TJ, Chen MS et al (2000) Epidemiologic study of type 2 diabetes in Taiwan. Diabetes Res Clin Pract 50(Suppl 2):S49–S59

    Article  PubMed  Google Scholar 

  3. Lin TL, Chen GD, Chen YC, Huang CN, Ng SC (2012) Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes. Taiwan J Obstet Gynecol 51:381–386

    Article  PubMed  Google Scholar 

  4. Gulur DM, Mevcha AM, Drake MJ (2011) Nocturia as a manifestation of systemic disease. BJU Int 107:702–713

    Article  PubMed  Google Scholar 

  5. Yoshimura K (2012) Correlates for nocturia: a review of epidemiological studies. Int J Urol 19:317–329

    Article  PubMed  Google Scholar 

  6. Chung MS, Chuang YC, Lee JJ, Lee WC, Chancellor MB, Liu RT (2014) Prevalence and associated risk factors of nocturia and subsequent mortality in 1,301 patients with type 2 diabetes. Int Urol Nephrol 46:1269–1275

    Article  PubMed  Google Scholar 

  7. van Kerrebroeck P, Abrams P, Chaikin D, Donovan J, Fonda D, Jackson S et al (2002) The standardisation of terminology in nocturia: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn 21:179–183

    Article  PubMed  Google Scholar 

  8. van Dijk L, Kooij DG, Schellevis FG (2002) Nocturia in the Dutch adult population. BJU Int 90:644–648

    Article  PubMed  Google Scholar 

  9. Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ et al (2009) Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. J Androl 30:1–9

    Article  PubMed  Google Scholar 

  10. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS et al (2010) Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 95:2536–2559

    CAS  Article  PubMed  Google Scholar 

  11. Grossmann M, Thomas MC, Panagiotopoulos S, Sharpe K, Macisaac RJ, Clarke S et al (2008) Low testosterone levels are common and associated with insulin resistance in men with diabetes. J Clin Endocrinol Metab 93:1834–1840

    CAS  Article  PubMed  Google Scholar 

  12. Kapoor D, Aldred H, Clark S, Channer KS, Jones TH (2007) Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care 30:911–917

    CAS  Article  PubMed  Google Scholar 

  13. Liao CH, Chiang HS, Yu HJ (2011) Serum testosterone levels significantly correlate with nocturia in men aged 40–79 years. Urology 78:631–635

    Article  PubMed  Google Scholar 

  14. Chuang YC, Chung MS, Wang PW, Lee WC, Chen CD, Chang HW et al (2012) Albuminuria is an independent risk factor of erectile dysfunction in men with type 2 diabetes. J Sex Med 9:1055–1064

    CAS  Article  PubMed  Google Scholar 

  15. Liu RT, Chung MS, Lee WC, Chang SW, Huang ST, Yang KD et al (2011) Prevalence of overactive bladder and associated risk factors in 1359 patients with type 2 diabetes. Urology 78:1040–1045

    Article  PubMed  Google Scholar 

  16. Homma Y, Yoshida M, Seki N, Yokoyama O, Kakizaki H, Gotoh M et al (2006) Symptom assessment tool for overactive bladder syndrome–overactive bladder symptom score. Urology 68:318–323

    Article  PubMed  Google Scholar 

  17. Liu CC, Wu WJ, Lee YC, Wang CJ, Ke HL, Li WM et al (2009) The prevalence of and risk factors for androgen deficiency in aging Taiwanese men. J Sex Med 6:936–946

    CAS  Article  PubMed  Google Scholar 

  18. Liu RT, Chung MS, Wang PW, Chen CD, Lee JJ, Lee WC et al (2013) The prevalence and predictors of androgen deficiency in Taiwanese men with type 2 diabetes. Urology 82:124–129

    Article  PubMed  Google Scholar 

  19. Coyne KS, Zhou Z, Bhattacharyya SK, Thompson CL, Dhawan R, Versi E (2003) The prevalence of nocturia and its effect on health-related quality of life and sleep in a community sample in the USA. BJU Int 92:948–954

    CAS  Article  PubMed  Google Scholar 

  20. Liu RT, Chung MS, Chuang YC, Lee JJ, Lee WC, Chang HW et al (2012) The presence of overactive bladder wet increased the risk and severity of erectile dysfunction in men with type 2 diabetes. J Sex Med 9:1913–1922

    CAS  Article  PubMed  Google Scholar 

  21. Nakamura M, Fujimura T, Nagata M, Hosoda C, Suzuki M, Fukuhara H et al (2012) Association between lower urinary tract symptoms and sexual dysfunction assessed using the core lower urinary tract symptom score and International Index of Erectile Function-5 questionnaires. Aging Male 15:111–114

    Article  PubMed  Google Scholar 

  22. Stein RA (2003) Endothelial dysfunction, erectile dysfunction, and coronary heart disease: the pathophysiologic and clinical linkage. Rev Urol 5(Suppl 7):S21–S27

    PubMed  PubMed Central  Google Scholar 

  23. Inci M, Sarli B, Davarci M, Yalcinkaya FR, Rifaioglu MM, Davran R et al (2013) Relationship between endothelial dysfunction and nocturia with benign prostatic hyperplasia. Scand J Urol 47:384–389

    Article  PubMed  Google Scholar 

  24. Weiss JP (2012) Nocturia: focus on etiology and consequences. Rev Urol 14:48–55

    PubMed  PubMed Central  Google Scholar 

  25. Kupelian V, Fitzgerald MP, Kaplan SA, Norgaard JP, Chiu GR, Rosen RC (2011) Association of nocturia and mortality: results from the Third National Health and Nutrition Examination Survey. J Urol 185:571–577

    Article  PubMed  Google Scholar 

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Funding

This study was supported by Chang Gung Medical Research Program (CMRPG-860381).

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Author notes

    Affiliations

    1. Division of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, #123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, 833, Taiwan

      Hui-Ying Liu, Hung-Jen Wang & Yao-Chi Chuang

    2. Division of Metabolism, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan

      Min-Shen Chung & Rue-Tsuan Liu

    Authors
    1. Hui-Ying Liu
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    2. Min-Shen Chung
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    3. Hung-Jen Wang
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    4. Rue-Tsuan Liu
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    5. Yao-Chi Chuang
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    Corresponding author

    Correspondence to Yao-Chi Chuang.

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    All author declare that they have no conflict of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Rue-Tsuan Liu and Yao-Chi Chuang have contributed equally to this contribution submission.

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    Liu, HY., Chung, MS., Wang, HJ. et al. Nocturia indicates a poor health status and increases mortality in male patients with type 2 diabetes mellitus. Int Urol Nephrol 48, 1209–1214 (2016). https://doi.org/10.1007/s11255-016-1310-3

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    • DOI: https://doi.org/10.1007/s11255-016-1310-3

    Keywords

    • Diabetes
    • Erectile dysfunction
    • Mortality rate
    • Nocturia
    • Testosterone