Lower Urinary Tract Symptoms in Women with Diabetes Mellitus: A Current Review
- 785 Downloads
A literature review of the most current publications studying lower urinary tract symptoms (LUTS) and findings in diabetic women was conducted including articles from January 2013 to April 2014. Current reports consistently note that aging and obesity are significantly associated with worsened LUTS in diabetic women. Glucosuria has variable effects on urodynamic parameters and LUTS, but has a significant association with urinary tract infection (UTI) and incontinence at clinically relevant numbers, such as HbA1C values. The presence of severe nocturia in diabetic patients warrants careful surveillance for cardiovascular risks given the significant association with mortality. Diabetics appear to be at higher risk for colonization with the virulent, extended-spectrum, β-lactamase-producing Escherichia coli and Klebsiella species in UTI. Novel therapies in glycemic control and for diabetic bladder dysfunction are undergoing animal model trials with encouraging results. The most promising of these includes stem cell therapy, although a need exists for human studies.
KeywordsDiabetes mellitus and lower urinary tract symptoms Stress urinary incontinence Urge incontinence Overactive bladder Urinary frequency Urgency Nocturia
Compliance with Ethics Guidelines
Conflict of Interest
Dr. Rebecca James and Dr. Adonis Hijaz each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 4.Brown JS, Vittinghoff E, Lin F, Nyberg LM, Kusek JW, Kanaya AM. Prevalence and risk factors for urinary incontinence in women with type 2 diabetes and impaired fasting glucose: findings from the National Health and Nutrition Examination Survey (NHANES) 2001-2002. Diabetes Care. 2006;29(6):1307–12.PubMedCrossRefPubMedCentralGoogle Scholar
- 10.Simkhada R. Urinary tract infection and antibiotic sensitivity pattern among diabetics. Nepal Med Coll J NMCJ. 2013;15(1):1–4.Google Scholar
- 14.Bani-Issa W, Almomani F, Eldeirawi K. Urinary incontinence among adult women with diabetes in Jordan: epidemiology, correlates and perceived impact on emotional and social well-being. J Clin Nurs. 2013.Google Scholar
- 15.Palleschi G, Pastore AL, Maggioni C, et al. Overactive bladder in diabetes mellitus patients: a questionnaire-based observational investigation. World J Urol. 2013.Google Scholar
- 18.••Chung MS, Chuang YC, Lee JJ, Lee WC, Chancellor MB, Liu RT. Prevalence and associated risk factors of nocturia and subsequent mortality in 1,301 patients with type 2 diabetes. Int Urol Nephrol. 2014. The alarming significance between nocturia of ≥ 3 times per night and cardiovascular mortality in diabetic patients warrants a provider to urge the patient to maintain vigilant surveillance with her primary care provider in routine cardiovascular risk screenings. In a sense, the symptom of nocturia may prove to be a valuable warning in the care of diabetic patients. Google Scholar
- 22.••Kim JH, Lee SR, Song YS, Lee HJ. Stem cell therapy in bladder dysfunction: where are we? And where do we have to go? BioMed Res Int. 2013;2013:930713. Stem cell therapy appears to have the most promising projection for future LUTS therapies, but focused efforts must be made to conduct human studies.PubMedPubMedCentralGoogle Scholar
- 28.Changxiao H, Zhengyong Y, Shibing Y, et al. Clinical and urodynamic evaluation of women referred with diabetes mellitus. Int Urogynecol J. 2014.Google Scholar
- 34.•Aswani SM, Chandrashekar U, Shivashankara K, Pruthvi B. Clinical profile of urinary tract infections in diabetics and non-diabetics. Australas Med J. 2014;7(1):29–34. The above study discusses how diabetics appear to be at higher risk for the most virulent strains of the common UTI microbes (extended-spectrum, β-lactamase-producing Escherichia coli and Klebsiella species; ESBL-EK), so continued research in therapies against these strains is warranted. E. coli has shown maximum sensitivity to carbapenems and the least susceptibility to ampicillin.PubMedCrossRefPubMedCentralGoogle Scholar
- 38.•Macvane SH, Tuttle LO, Nicolau DP. Impact of extended-spectrum beta-lactamase-producing organisms on clinical and economic outcomes in patients with urinary tract infection. J Hosp Med Off Publ Soc Hosp Med. 2014;9(4):232–8. The above study discusses how diabetics appear to be at higher risk for the most virulent strains of the common UTI microbes (extended-spectrum, β-lactamase-producing Escherichia coli and Klebsiella species; ESBL-EK), so continued research in therapies against these strains is warranted. E. coli has shown maximum sensitivity to carbapenems and the least susceptibility to ampicillin.CrossRefGoogle Scholar
- 40.Dixon L, Winkler M. Emphysematous cystitis: a tympanic bladder. BMJ Case Rep. 2013;2013.Google Scholar
- 43.Nicolle LE, Capuano G, Ways K, Usiskin K. Effect of canagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, on bacteriuria and urinary tract infection in subjects with type 2 diabetes enrolled in a 12-week, phase 2 study. Curr Med Res Opin. 2012;28(7):1167–71.PubMedCrossRefGoogle Scholar