Endocrine Abstracts

Background and Aims: Lower urinary tract (LUT) dysfunctions are highly prevalent, especially in women. Diabetes is a well-established risk factor for developing LUT symptoms. Several studies suggest that a high body mass index (BMI) may worsen the urinary discomfort in patients with type 2 diabetes (T2DM). The current survey aims to investigate the relationship between obesity and LUT dysfunctions in patients with T2DM.

Patients and Method: We conducted a descriptive and analytical cross-sectional study that included 200 patients with T2DM consulting at the Endocrinology Department of Hedi Chaker University Hospital, Sfax, Tunisia, from April 2019 to December 2019. We administrated the Urinary Symptom Profile (USP) questionnaire to all patients to assess LUT symptoms.

Results: The mean age was 59.3 ± 10.6 years, with a female predominance (55.5%). Dyslipidemia (57%) and hypertension (49.7%) were the most common comorbidities. The duration of the evolution of diabetes was 11.0 ± 7.9 years. Oral antidiabetic agents (OAD) and insulin therapy were prescribed in 40% and 13.6%, respectively. Most of the patients were receiving a mixed insulin-OAD treatment (44.2%). A glycemic imbalance was noted in 79.7%. As high as 79.5% of patients with T2DM reported symptoms related to LUT dysfunctions.We compared the body composition in two subgroups• G1 : patients with LUT dysfunction (n = 159).• G2: patients without LUT dysfunction (n = 41).The mean weight in G1 was significantly more elevated than in G2 (77.5 ± 13.8 versus 70.3 ± 11.1 kg; P = 0.003). Similarly, G1 displayed a substantially higher BMI than G2 (29.2 ± 5.8 versus 26.4 ± 4.2 kg/m^²; P = 0.03). The prevalence of obesity ( BMI>30) was significantly higher in G1 (34.0%) compared to G2 (14.6%) (P = 0.016). Abdominal adiposity with significantly associated with LUT symptoms, since the average waist circumference was higher in G1 in comparison with G2 (103.5 versus 95.7 cm; P = 0.01).

Conclusion: Diabetes and the female gender are largely linked to the onset of LUT dysfunctions in the general population. Our work highlights an additional risk of urinary dysfunction due to weight gain, high BMI, and visceral adiposity in patients with T2DM. Increasing weight is associated with urinary incontinence and other LUT symptoms, most likely because of elevated pressure on the bladder and straining the muscles that support the urethra. These mechanisms, along with hyperglycemia-related osmotic polyuria and diabetic neuropathy are responsible for a greater prevalence and worsened quality of life in this population.