Biochemical Measures of Diabetes are Not Independent Predictors of Urinary Incontinence in Women

Abstract

Diabetes mellitus type II is considered an important risk factor for urinary incontinence. We investigated associations among biochemical measures of diabetes with stress and urgency urinary incontinence in a nationally representative sample of American women. We performed a cross-sectional analysis of female adult participants in the 2001 to 2010 NHANES (National Health and Nutrition Examination Survey). Urinary incontinence was ascertained by self-report. Diabetes was defined by calculated measures of glycemic control and insulin resistance. Glycemic control was classified by HbA1c and fasting plasma glucose. Insulin resistance was estimated by fasting plasma insulin and the homeostasis model assessment of insulin resistance definition. Logistic regression models adjusted for sociodemographic variables and risk factors were fitted for each measure of diabetes mellitus type II severity, and stress and urgency urinary incontinence. Stepwise multivariable logistic regression models were developed to characterize independent risk factors for these conditions. Compared to women with normal HbA1c participants with diabetes mellitus type II had an increased prevalence of stress and urge urinary incontinence (38.6% vs 52.5% and 21.7% vs 40.3%, respectively, each p<0.001). Diabetes measures were each significantly associated with urinary incontinence in unadjusted models. However, they were not independently associated with stress or urge urinary incontinence in multivariable models when adjusted for patient body mass index. Despite an increased prevalence of stress and urge urinary incontinence among women with diabetes, measures of diabetes mellitus type II are not independently associated with female incontinence. Rather, body mass index and several other characteristics are the dominant risk factors for stress or urge urinary incontinence.