Endocrine Abstracts

Background and Aims: Several studies have pointed a significant relationship between diabetic complications, glycemic imbalance, and the onset of lower urinary tract dysfunction (LUTD) in this population. The current survey aims to assess the clinical and biochemical characteristics related to glycemic control in patients with type 2 diabetes presenting with symptoms of LUTD.

Patients and Method: We conducted a comparative 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. We compared the clinical and biological factors related to diabetes in two subgroups.• G1 : patients with LUTD (n = 159).• G2: patients without LUTD (n = 41)

Results: The mean age was similar between the two subgroups (G1:59.7± 10.3 versus G2:58.0 ± 11.8 years old; P = 0.36). A slight female predominance was noted in G2 (G1:52.0% versus G2:63.4%; P = 0.16). The mean duration of T2DM was significantly longer in G1 (G1:11.9 versus G2: 7.7 years; P = 0.03). Insulin-requiring diabetes was substantially more associated with LUTD as insulin therapy was more prescribed for G1 (G1:62.0% versus G2: 42.5%; P = 0.025). Unlike diabetic retinopathy (P = 0.07), diabetic nephropathy (P = 0.021) and nephropathy (P = 0.000) were strongly associated with the onset of LUTD. Diabetic macroangiopathy did not seem to be linked to this urinary disorder. A significant glycemic imbalance was noted in G1 with more elevated fasting plasma glucose (G1:10.7± 4.4 versus G2:7.5 ± 1.2 mmol/l; P = 0.000) and higher A1C (G1:9.5± 2.3% versus G2:8.1 ± 2.4%; P = 0.000). Multivariable regression analysis identified duration of evolution of diabetes (OR=1.1; 95%CI [1.0-1.2]; P = 0.033), diabetic neuropathy (OR=6.4; 95%CI [2.4-17.3]; P = 0.000), and A1C>7% (OR=0.4; 95%CI [0.2-0.6]; P = 0.045) as significant risk factors implicated in the onset of LUTD.

Conclusion: Glycemic imbalance, diabetic microangiopathy, and diabetic neuropathy were found to be significant baseline characteristics associated with the onset of LUTD in the diabetic population. Glycemic control and therapeutic patient education are the most efficient preventive measures to reduce the incidence of LUTD in patients with T2DM. A multidisciplinary approach including a team of diabetologists, urologists, and physiatrists may ensure well-coordinated management of patients presenting with LUTD.