Recent epidemiological evidence suggests that incontinence is associated with type 2 diabetes and is 50% to 200% more common among women with type 2 diabetes than among women with normal glucose levels, write Suzanne Phelan, PhD, from California Polytechnic State University in San Luis Obispo, and colleagues from the Action for Health in Diabetes (Look AHEAD) Research Group. A likely etiology for incontinence in diabetes is microvascular damage, similar to the disease process involved in development of retinopathy, nephropathy, and neuropathy. Few studies have examined both the prevalence and risk factors for overall and type of incontinence (urgency and stress incontinence) among different racial/ethnic groups of women with type 2 diabetes.
By using data from the Look AHEAD study, this cross-sectional analysis aimed to assess the prevalence and risk factors for urinary incontinence among different racial/ethnic groups of overweight and obese women with type 2 diabetes. The randomized clinical trial Look AHEAD enrolled 2994 overweight or obese women with type 2 diabetes.
Weekly incontinence compared to any other diabetes-associated complication was more prevalent and was reported by 27% of participants vs rates of 7.5% for retinopathy, 2.2% for microalbuminuria, and 1.5% for neuropathy.
Non-Hispanic whites had the highest prevalence of weekly incontinence (32%), whereas African Americans and Asians had the lowest prevalence (18% and 12%, respectively; P < .001). Compared with non-Hispanic white women, Asian women had 75% lower odds of weekly incontinence and African American women had 55% lower odds (P < .001).
Compared with nonobese women, those with a body mass index (BMI) of > 35 kg/m2 had higher odds of overall incontinence (55% higher) and stress incontinence (85% higher; P < .03). Other risk factors for overall, stress, and urgency incontinence were a history of hysterectomy (40% – 80% increased risk; P < .01) and urinary tract infection (UTI) in the past year (55% – 90% increased risk; P < .001).
Among overweight and obese women with type 2 diabetes, urinary incontinence is highly prevalent and far exceeds other diabetes complications, the study authors write. Racial/ethnic differences in incontinence prevalence are similar to women without diabetes, affecting non-Hispanic Whites more than Asians and African Americans. Increasing obesity (BMI > 35) was the strongest modifiable risk factor for overall incontinence and stress incontinence in this diverse cohort.
The study drawbacks included cross-sectional design, urinary incontinence based on self-report and sampling factors that may have prevented detection of relationships between diabetes complications and incontinence.
Physicians should be alert for incontinence among women with type 2 diabetes, the study authors conclude. Data from the Look AHEAD trial will determine whether weight loss has an impact on reducing urinary incontinence among women with type 2 diabetes.
