Storage and voiding symptoms show distinct etiologies in people with type 2 diabetes

The lower urinary tract symptoms (LUTS) of storage and voiding may differ in their pathogenic origin in people with type 2 diabetes, warranting tailored management, say Japanese investigators.

As reported in The Journal of Medical Investigation in August 2024, they found that the prevalence of LUTS was higher in people with type 2 diabetes compared with Japanese population norms, according to International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS) questionnaire.

Specifically, overactive bladder (OAB) occurred in 21.9% of the 160 hospitalized participants with type 2 diabetes, versus previously reported rates of 12.4% for the general population aged over 40 years, while storage and voiding symptoms occurred in 63.8% and 39.4% of patients, respectively.

The patients were aged an average of 61.5 years, and the majority (56.9%) were men. 

After taking into account age and sex, the 35 patients with type 2 diabetes and OAB were significantly more likely than the 125 patients with type 2 diabetes only to have autonomic neuropathy, as indicated by a decreased coefficient of variation of the R-R interval (CVR-R) on electrocardiogram, at 1.5% versus 2.2%, and they were significantly less likely to have dyslipidemia, at rates of 57.1% versus 75.2%. 

For the 102 patients with storage symptoms, significant positive associations were seen on multivariate analysis for BMI and duration of diabetes, giving odds ratios relative to the 58 patients without storage symptoms of 1.09 and 1.00, respectively. BMI was 27.1 kg/m2 versus 26.1 kgm2 and diabetes duration was 120 versus 60 months.

“Given that autonomic neuropathy is one of the microvascular complications and the duration of [diabetes mellitus] is closely associated with microvascular complications, our findings raise the possibility of a link between storage symptoms and microvascular complications,” say Toshio Hosaka (University of Shizuoka) and colleagues.

By comparison, the only significant association for the 63 patients with voiding symptoms versus the 97 without was with cerebrovascular disease, which was present in 12.7% versus 1.0% of patients, respectively, although this association was no longer significant in multivariate analysis. 

The investigators point out that cerebrovascular disease is “a significant macrovascular complication,” and that the “pathogenesis differs between microvascular and macrovascular complications, necessitating distinct management strategies for these disorders.”

They explain: “Glucose lowering treatment is recommended to mitigate the impact of microvascular complications, whereas modifications of cardiovascular risk factors, such as hypertension, dyslipidemia, and smoking, diminish the impacts of macrovascular complications.”

As a pilot study, the findings need to be validated in large-scale, multicenter trials, say the authors, who nevertheless conclude that their findings emphasize the need for tailored strategies to manage storage and voiding in patients with type 2 diabetes.

Such that, “glucose lowering treatment might be recommended to prevent storage symptoms, while modifications of cardiovascular risk factors would presumably be advisable when the aim is to prevent voiding symptoms.”

News stories are provided by medwireNews, which is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group

Read the article here: J Med Invest 2024: 71; 237–245 

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