Glycaemic control and risk of incident urinary incontinence in women with Type 1 diabetes: results from the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study

• Published in: Diabetic medicine 2016-11, Vol.33 (11), p.1528-1535
• Main Authors: Lenherr, S. M., Clemens, J. Q., Braffett, B. H., Dunn, R. L., Cleary, P. A., Kim, C., Herman, W. H., Hotaling, J. M., Jacobson, A. M., Brown, J. S., Wessells, H., Sarma, A. V.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Blood Glucose - metabolism; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - therapy; Female; Follow-Up Studies; Glycated Hemoglobin A - metabolism; Humans; Incidence; Middle Aged; Multicenter Studies as Topic - statistics & numerical data; Randomized Controlled Trials as Topic - statistics & numerical data; Risk Factors; Surveys and Questionnaires; Urinary Incontinence - blood; Urinary Incontinence - epidemiology; Urinary Incontinence - etiology; Young Adult
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13126

Aims To study the impact of glycaemic control on urinary incontinence in women who participated in the Diabetes Control and Complications Trial (DCCT; 1983–1993) and its observational follow‐up study, the Epidemiology of Diabetes Interventions and Complications (EDIC; 1994–present). Methods Study participants were women who completed, at both years 10 (2003) and 17 (2010) of the EDIC follow‐up, the urological assessment questionnaire (UroEDIC). Urinary incontinence was defined as self‐reported involuntary leakage of urine that occurred at least weekly. Incident urinary incontinence was defined as weekly urinary incontinence present at EDIC year 17 but not at EDIC year 10. Multivariable regression models were used to examine the association of incident urinary incontinence with comorbid prevalent conditions and glycaemic control (mean HbA1c over the first 10 years of EDIC). Results A total of 64 (15.3%) women with Type 1 diabetes (mean age 43.6 ± 6.3 years at EDIC year 10) reported incident urinary incontinence at EDIC year 17. When adjusted for clinical covariates (including age, DCCT cohort assignment, DCCT treatment arm, BMI, insulin dosage, parity, hysterectomy, autonomic neuropathy and urinary tract infection in the last year), the mean EDIC HbA1c was associated with increased odds of incident urinary incontinence (odds ratio 1.03, 95% CI 1.01–1.06 per mmol/mol increase; odds ratio 1.41, 95% CI 1.07–1.89 per % HbA1c increase). Conclusions Incident urinary incontinence was associated with higher HbA1c levels in women with Type 1 diabetes, independent of other recognized risk factors. These results suggest the potential for women to modify their risk of urinary incontinence with improved glycaemic control. (Clinical Trials Registry no: NCT00360815 and NCT00360893). What's new? Research to date has failed to show an association between glycaemic control and urinary incontinence (UI) in women with diabetes. We examined the relationship between HbA1c and UI using longitudinal data from the Diabetes Control and Complications Trial (DCCT) and its observational follow‐up, the Epidemiology of Diabetes Interventions and Complications (EDIC) study. Our findings show that the odds of UI increase with poor glycaemic control in women with Type 1 diabetes, independently of other well‐described predictors of UI.