Current Treatment of Overactive Bladder in Patients with Diabetes and Obesity
A review and assessment of five current research studies for the efficacy in managing overactive bladder syndrome, particularly in patients with metabolic disease.
October 2019
Volume 1, Issue 8

Interrelationship between Overactive Bladder and Type 2 Diabetes

The severity of OAB was explored in relation to risk factors and disease complications that commonly arise in patients with diabetes.

Int J Clin Pract. 2019;:e:13395

A prospective, cross-sectional study was conducted to examine the severity of overactive bladder syndrome (OAB) against factors such as age, sex, and diabetes-related factors such as body mass index, duration of diabetes, and diabetes-related complications among 457 individuals with type 2 diabetes (T2D) and OAB at the Jinhua Hospital, in China.

A diagnoses of T2D was based on World Health Organization guidelines (fasting plasma glucose 7 mmol/L or higher, or postprandial glucose 11.1 mmol/L or higher) and confirmed by endocrinologists at the hospital. An OAB diagnoses were determined based on an urgency score of 2 or higher and an overall score of 3 or higher on the Chinese version of the Overactive Bladder Symptom Score (OABSS).1,2

The investigators excluded patients with pelvic organ prolapse, spinal cord injury, neuropathies such as Parkinson’s disease or multiple sclerosis, previous bladder or urethral lesions, a history of urinary tract tuberculosis, a history of major pelvic or bladder surgery, urinary tract infections, or gestational diabetes.

Study participants completed a questionnaire that included demographic information and items related to diabetes and overactive bladder. They also underwent clinical examination for symptomatic diabetic peripheral neuropathy, as indicated by pinprick, temperature, vibration perception, and monofilament pressure sensation.

Then, these individuals were stratified by OAB symptom severity based on OABSS: scores of 3 to 5 were classified as mild, scores of 6 to 11 were classified as moderate, and scores of 12 to 15 were severe. The median age of the study population was 62.1 years, and the mean duration of diabetes was 11.3 years. Mean body mass index was 24.3.

The investigators reported significant differences between the mild-severity and moderate-to-severe-severity groups with respect to age, duration of diabetes, bilateral ankle reflex, and symptomatic diabetic peripheral neuropathy. Moderate to severe OAB was associated with age older than 60 years (odds ratio [OR] 2.11, 95% confidence interval [CI] 1.36-2.93,  P= 0.011), having diabetes for 10 years or longer (OR 1.49, 95% CI 1.02-2.17, P = 0.029), absence of ankle reflexes (OR 1.29, 95% CI 1.02-2.01, P = 0.049), and presence or absence of symptomatic diabetic peripheral neuropathy (OR 2.47, 95% CI 1.71-3.53, P = 0.009).

In multivariate analyses, age 60 or older (OR 1.59, 95% CI 1.01-2.44, P = 0.036), diabetes duration longer than 10 years (OR 1.41, 95% CI 1.01-2.06, P = 0.049), and the presence or absence of symptomatic diabetic peripheral neuropathy (OR 2.39, 95% CI 1.63-3.54, P = 0.012) remained as independent risk factors associated with OAB progression. These findings were consistent with another study showing a close association between diabetic peripheral neuropathy and age or diabetes duration.2

The investigators reported that most study participants were older adults whose bladder dysfunction may have arise in response to other conditions such as benign prostatic hyperplasia, uracratia, or urinary tract infections. Transrectal ultrasounds and urine flow rate were conducted to correct for this potential confounder. Both recall bias and patients coming from this single center were also cited as study limitations.

On the basis of their data, however, the authors concluded that symptomatic diabetic peripheral neuropathy, duration of diabetes, and age should be monitored when clinicians are evaluating patients with diabetes and OAB. They also suggested that the likelihood of diabetic peripheral neuropathy and worsening overactive bladder symptoms appears to have increased with diabetes duration and age.

Expert Commentary Suggests Need to Assess for OAB in Patients with Diabetes

The authors surmised that an association between diabetic peripheral neuropathy (DPN) and OAB has a neurogenic basis, such that DPN was characterized mainly by demyelinization and axonal degeneration that follow progressive and chronic hyperglycemia.

As in peripheral neuropathy in patients with diabetes, the peripheral and autonomic neuropathy that is associated with diabetic bladder dysfunction stems from impairment of afferent pathways that may result in impaired bladder sensation and detrusor contractility.

The authors, however, did not rule out other potential causes. Although the cited limitations in this study are valid, it is notable that obesity, a common confounder in studies of both OAB and diabetes mellitus, did not arise as a factor in the outcomes of this trial (mean BMI 24.3 kg/m2 ± 4.4).

Commentary

Next Article:
Assessing the Risk of OAB in Individuals with Metabolic Disease
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