Urologic Diseases Research Updates
Spring/Summer 2009

Urinary Incontinence More Common among Women with Type 1 Diabetes

A study funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has found that women with type 1 diabetes are more likely to experience urinary incontinence (UI). Among study participants, UI was more prevalent than other commonly recognized type 1 diabetes-associated complications, including neuropathy, retinopathy, and nephropathy.

“Physicians treating women with type 1 diabetes should be alert for incontinence, which is often unrecognized and, therefore, undertreated among women with diabetes,” wrote Aruna V. Sarma, Ph.D., M.H.A., Assistant Research Professor, University of Michigan, et al., in the March 2009 Journal of Urology.

The finding is from the Epidemiology of Diabetes Interventions and Complications Study (EDIC), which is examining a subset of volunteers who participated in the Diabetes Control and Complications Trial (DCCT).

The DCCT was a multicenter trial of 1,441 type 1 diabetes patients ages 13 to 39 that showed intensive glucose control could significantly reduce diabetes-related eye, nerve, and kidney complications. Intensive glucose control was defined as keeping hemoglobin A1C—a 3-month average blood glucose level—below 6 percent.

Ongoing Study

The EDIC is an ongoing, observational study of DCCT participants. Participants agreed to answer health-related questions and to undergo periodic A1C, blood lipid, blood pressure, eye, and kidney testing. The NIDDK launched Uro-EDIC—guided by the Urological Complications of Diabetes Group—to evaluate type 1 diabetes urological complications among EDIC participants.

Two common types of UI among women are urge incontinence and stress incontinence. Urge incontinence—urine leakage after a sudden urge to urinate—can result from damage to nerves that control the bladder. Stress incontinence—urine leakage while sneezing, coughing, or exercising—is due to injuries to bladder-support muscles, which can occur during childbirth. About 24 percent of all women experience some degree of UI.

People with type 1 diabetes have difficulty regulating blood glucose levels because of an autoimmune process that destroys the insulin-producing beta cells of the pancreas. Over time, high blood glucose levels, a condition called hyperglycemia, damages the body’s nerves and blood vessels leading to complications such as heart disease, stroke, blindness, and lower limb amputations.

Uro-EDIC participants were questioned about UI symptoms: how many times per week and month they leaked urine, how much urine they leaked, what they were doing when they leaked urine, how much urine leakage bothered them, and if urine leakage affected their daily activities.

The researchers compared Uro-EDIC data with a similar nondiabetic group that participated in the National Health and Nutrition Examination Survey (NHANES)—a Centers for Disease Control and Prevention-sponsored survey of U.S. residents.

Markedly Higher Risk

“We found that young and middle-aged women with type 1 diabetes have a markedly higher risk of weekly urge incontinence compared with women with normal glucose levels,” wrote Sarma and co-authors.

About 19 percent of Uro-EDIC women reported having UI weekly or more often, compared with about 15 percent of NHANES participants. Uro-EDIC participants were almost twice as likely to have urge incontinence weekly or more often and 38 percent more likely to have stress incontinence weekly or more often. Stress incontinence was even more common after adjusting for fewer births among the Uro-EDIC women. Childbirth history is an established UI risk factor.

UI was more prevalent among Uro-EDIC women than eye, nerve, or kidney complications, suggesting UI may be an early indicator of diabetes-related microvascular and nerve damage. Sarma and colleagues hypothesized that type 1 diabetes damages bladder nerves or alters bladder muscle function, resulting in UI.

For more information about the DCCT and the EDIC, visit www.diabetes.niddk.nih.gov/dm/pubs/control.

The National Kidney and Urologic Diseases Information Clearinghouse, an information service of the NIDDK, offers free fact sheets and easy-to-read booklets about UI. For more information, visit www.kidney.niddk.nih.gov.

For more information about diabetes, visit the National Diabetes Information Clearinghouse at www.diabetes.niddk.nih.gov.

NIH Publication No. 09–5743
August 2009

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