Table 1.
Studies of bladder dysfunction in diabetes
| Authors (Year) | Overall Population (Diabetes type) |
Definition of Neuropathy |
Definition of Bladder Dysfunction |
Findings |
|---|---|---|---|---|
| Men and Women | ||||
| Wessells et al (2018) | 1059 T1DM DCCT/EDIC study | CAN: R-R variation <15, or R-R variation 15-19.9 plus Valsalva ratio ≤1.5, 10 mm Hg drop in DBP | LUTS, UTI | In men, age associated with LUTS, and persistence of LUTS. HbA1C in women associated with emergence of LUTS and persistent UI. |
| Wilke et al (2015) | 456,586 T2DM | n/a | UTI | Highest UTI event rates in those aged >89 years. Most important factors in UTI risk were older age, female gender, UTIs in the previous 2 years, number of comorbidities, and at |
| Pavy-Le Traon et al (2010) | 684 T1DM | CAN severity Ewing Score (0-5): deep breathing, Valsalva, stand test, HRV, SBS | Bladder dysfunction symptoms | Bladder dysfunction independently associated with CAN |
| Liu et al (2011) | 1359 T2DM | Detailed interview | OAB symptom score | The prevalence of OAB and OAB wet was 2.4-fold and 4.2-fold greater, in patients with diabetes duration>10 years and age>50 years. Age and male sex were independent risk factors for OAB, age and waist circumference were independent risk factors for OAB wet. |
| Esteghamati et al. (2007) | 66 | Neurological consultation for the presence of peripheral somatic neuropathy (sensory, motor). | IPSS | Female sex was associated with increased bladder capacity. Male sex was associated with decreased bladder compliance and bladder outlet obstruction. Old age associated with low flow rate and outlet obstruction. Detrusor instability associated with shorter duration of diabetes. Peripheral somatic neuripathy associated with low flow rate. |
| Kebapci et al (2007) | 54 T2DM 27 males 27 females | CAN: deep breathing, Valsalva, stand test | LUTS: IPSS, Urinary Incontinence, Urodynamic studies | QT prolongation associated with with increased Post void residual urine OR 2.33 (0.16-34.89) |
| Low et al (2004) | 231 T1DM/T2DM | Autonomic Symptom Profile (ASP) Composite Autonomic Severity Score (CASS) | ASP urinary domain: Bladder Dysfunction, Sexual dysfunction (males only) | Significant correlations between ASP urinary domain and overall CASS and domain scores |
| Ueda et al (2000) | 3500 n/a | 23 item urinary incontinence questionnaire | Urinary incontinence | Women with history of diabetes mellitus had increased risk for UI |
| Ueda et al (1997) | 63 Diabetes* | Sympathetic skin response: Mystro plus MS20 | Volume at first desire to void Max bladder capacity Bladder pressure Residual urine | Mean Vol. at first desire to void, Max bladder capacity lower for Sympathetic Skin response absent. Mean Bladder pressure and Residual urine greater for Sympathetic Skin response absent. |
| Men | ||||
| Pop-Busui et al (2015) | 635 T1DM DCCT/EDIC Study | CAN: R-R variation <15, or R-R variation 15-19.9 plus Valsalva ratio ≤1.5, 10 mm Hg drop in DBP | LUTS: AUASI 8-35 | LUTS prevalence: 158 (25%) Odds of ED+LUTS: 2.65 (1.47-4.79) |
| Sarma et al (2012) | 186 | n/a | LUTS: AUASI | Men with diabetes had higher odds of moderate/severe LUTS. Those not taking medications had higher odds of worse LUTS than those taking medications. |
| Bansal et al (2011) | 52 Diabetes* | Sympathetic skin response: Medtronic electromyographic system | LUTS: IPSS 8-35 Urodynamic studies | Diabetic cystopathy correlated with abnormal motor and sensory nerve conduction velocity studies and abnormal sympathetic skin responses |
| Joseph et al (2003) | 708 n/a | n/a | LUTS: AUASI | History of diabetes was positively associated with LUTS |
| Michel et al (2000) | 1290 Diabetes* | n/a | LUTS: IPSS | Older age and IPSS independently associated with increased odds of having diabetes. Diabetics had significantly greater IPSS and smaller maximum flow rate than non-diabetic patients. |
| Women | ||||
| Tai et al. (2016) | 400 T2DM | Medical history of peripheral neuropathy | LUTS: AUASI | Women with poor glycemic control more likely to develop urinary retention. Diabetic neuropathy significant predicted LUTS. |
| Hotaling et al (2016) | 571 T1DM DCCT/EDIC Study | CAN: R-R variation <15, or R-R variation 15-19.9 plus Valsalva ratio ≤1.5, 10 mm Hg drop in DBP | UI: Sandvik Severity Index 3-12 | UI prevalence: 172 (30%) |
| Lenherr et al (2016) | 64 T1DM DCCT/EDIC Study | CAN: R-R variation <15, or R-R variation 15-19.9 plus Valsalva ratio ≤1.5, 10 mm Hg drop in DBP | UI: Sandvik Severity index | 15.3% of women with T1DM reported incident UI. Mean HbA1c was associated with increased odds of incident UI. |
| Lenherr et al (2016) | 572 T1DM DCCT/EDIC Study | CAN: R-R variation <15, or R-R variation 15-19.9 plus Valsalva ratio ≤1.5, 10 mm Hg drop in DBP | Self-report | 15% of women reported at least one UTI in 12 months. Higher HbA1C associated with number of UTIs. |
| Boyko et al (2005) | 218 Diabetes* | n/a | UTI, asymptomatic bacteriuria, PVR | Increased risk of UTI in women with diabetes, specifically women taking insulin and women with longer diabetes duration. Increased asymptomatic bacteriuria in women with diabetes. |
| Lee et al (2004) | 194 | Detailed questioning about symptoms of paresthesia, dulled sensation, pain in legs and feet, measurement of sensory threshold (vibratory and thermal) on the feet. | LUTS: AUASI, PVR | Women with diabetes had higher nocturia scores, weaker urinary streams, less voided volumes, and lower maximal flow rates. Diabetes significant associated with decrease in baseline maximum flow. Peripheral neuropathy indepently associated with decrease in emptying efficiency. |
| Geerlings et al (2000) | 589 T1DM and T2DM | n/a | UTI | 14% of women with T1DM developed UTI, 23% of women with T2DM developed UTI. Risk factors for UTI development was presence of asymptomatic bacteriuria |
*
Type of diabetes not indicated
Note: AUASI, American Urological Association Symptom Index; CAN, cardiovascular autonomic neuropathy; DBP, diastolic blood pressure; DCCT/EDIC, Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications; ED, erectile dysfunction; HRV, heart rate variability; IIEF, International Index of Erectile Dysfunction; IPPS, International Prostate Symptom Score; LUTS, lower urinary tract symptoms; SBS, spontaneous baroreflex slope; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus; OAB, overactive bladder; UI, urinary incontinence