Urologic Complications Common in Type 1 Diabetes

Miriam E. Tucker

August 24, 2018

Urologic complications are present in about two thirds of adults with long-duration type 1 diabetes, new research suggests.

The findings, from an ancillary study to the Epidemiology of Diabetes Interventions and Complications (EDIC) study  — the observational follow-up to the landmark Diabetes Control and Complications Trial (DCCT) — were published online August 13 in Diabetes Care.

"Urological complications are prevalent and frequently coexist in men and women with type 1 diabetes," write Hunter B. Wessells, MD, from the Department of Urology and Diabetes Research Center, University of Washington, Seattle, and colleagues. "As improvements in diabetes management reduce the severity of retinopathy, nephropathy, and neuropathy, urological complications may become important drivers of quality of life."

The DCCT, which proved the benefits of tight glycemic control in reducing microvascular complications in type 1 diabetes, ended early in 1993 after a mean follow-up of 6.5 years. In 1994, 96% of the original 1441 participants transitioned into EDIC, at which point they had a mean age of 33.6 years and mean diabetes duration of 12.2 years. 

All were invited to participate in the ancillary Urologic EDIC (UroEDIC) study, which involved a series of well-validated self-administered urologic symptom questionnaires. A total of 508 women and 551 men completed the surveys at two time points: UroEDIC I  in 2003 and UroEDIC II in 2010-2011. 

Overall, 65% of women and 68% of men reported at least one urologic

complication at UroEDIC II. Among the women, 22% reported lower urinary tract symptoms, 42% sexual dysfunction, 31% urinary incontinence, and 17% urinary tract infection.

Among the men, 24% reported lower urinary tract symptoms, 45% erectile dysfunction, 40% low sexual desire, and 14% orgasmic dysfunction.

Among sexually active women, 35% reported no urologic complications, 39% had one, and 26% had two or more other complications. Lower urinary tract symptoms commonly co-occurred with other urologic complications, whereas female sexual dysfunction occurred more often in isolation. 

In the men, 31% reported no urologic complications, 36% had one, and 33%

had two or more. Here, lower urinary tract symptoms occurred more commonly in isolation, whereas erectile dysfunction, low sexual desire, and orgasmic dysfunction tended to co-occur.

Higher hemoglobin A1c levels were associated with increased risk for urologic complications in both women and men. For women, the risk for lower urinary tract symptoms among those in the highest hemoglobin A1c quartile (>8.54%) was over twice as high as among those in the lowest quartile (≤7.38%). For the men, those in higher HbA1c quartiles had higher odds for both erectile dysfunction and orgasmic dysfunction.

Body mass index of 30 kg/m2 or higher was associated with a greater risk for urinary incontinence in women but not with urologic complications among the men. Diabetic neuropathic and microvascular complications were also associated with urologic complications in both men and women.

The EDIC studies are funded by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Diabetes Care. Published  online August 13, 2018. Abstract   

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