Research shows urological issues more frequent than once thought.
Major complications of type 1 diabetes include retinopathy, nephropathy, neuropathy, and cardiovascular disease. Other complications that are less studied are urological conditions. Urological complications can be severe for people who have type 1 diabetes.
Some complications include sexual dysfunction, urinary tract infections, lower urinary tract symptoms, and urinary incontinence. Quality of life is a major concern with urological conditions and can negatively affect a person’s health. In addition, these issues are associated with higher A1C levels. The Urologic Epidemiology of Diabetes Interventions and Complications (UroEDIC) was established to study these complications.
The study used questionnaires distributed to men and women enrolled in a clinical study, Diabetes Control and Complications Trial (DCCT) on type 1 diabetes. The trial enrolled 1,441 subjects randomized into an intensive insulin therapy group and a conventional therapy group. After this study concluded, participants were enrolled in the UroEDIC trial, which assessed urinary and sexual dysfunction. Primary outcomes included male and female sexual dysfunction, female urinary incontinence, male and female lower urinary tract symptoms, and urinary tract infection frequency.
A total of 508 women and 551 men completed the urological surveys. In men, age was linked with lower urinary tract symptoms and HbA1c was associated with persistent erectile dysfunction. The intensive insulin treatment group had no association with emergence or persistence of complications. There were 65% of women and 68% of men who reported at least one urological complication. Women with highest HbA1c percentiles (over 8.54%) were two times more likely to report lower urinary tract symptoms compared to those with a HbA1c less than 7.38%. Also BMI over 30 kg/m2 had higher incidences of urinary incontinence in women. In men, higher BMI did not lead to more risk of urological complications. Men and women with any diabetes-related microvascular complication, like nephropathy or peripheral neuropathy, had higher odds of reporting a urological complication.
The highest reported urological complication in women was sexual dysfunction, however this complication was linked to age and not glycemic control. The second most reported complication in females was urinary incontinence. Thirty-one percent of women reported this complication compared to 17% of women in the National Health and Nutrition Examination Survey.
In men, erectile dysfunction was the most common reported complication with low sexual desire highly prevalent also. Twenty-five percent of men reported lower urinary tract symptoms as moderate to severe. This could be from benign prostatic hyperplasia sometimes seen in people who have diabetes. Most of the complications found were still persistent at the 7-year mark in the study.
With such a high reported rate of at least one urological complication, these complications cause significant reduced quality of life for people who have type 1 diabetes. This study also found co-occurring urological complications exist in these patients at high rates. These complications affect the urinary tract as well as sexual function in these individuals and a lower quality of life. Remission was seen in subsets of the participants and further research into this area would benefit people who have type 1 diabetes.
- Urological complications are prevalent among a large number of people who have type 1 diabetes.
- Women face more issues of urinary incontinence while men reported erectile dysfunction as major complication associated with higher A1C levels.
- Recommendations to keep HbA1c levels lower should help with urological complications, but more research is needed assess remission of these complications in people who have type 1 diabetes.
Hunter Wessells, Barbara H. Braffett, Sarah K. Holt, Alan M. Jacobson, John W. Kusek, Catherine Cowie, Rodney L. Dunn, Aruna V. Sarma, the DCCT/EDIC Study Group. 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. Diabetes Care (Oct 2018), 41 (10) 2170-2177; DOI: 10.2337/dc18-0255
Angela Reyes, Pharm.D. Candidate, LECOM College of Pharmacy