Diabetes Facts:
• It is the fastest growing disease in the world14.
• Every day in Australia approx. 275 adults develop diabetes15.
• In New Zealand about 110,000 people have Type 2 diabetes16.
• A healthy lifestyle is the best way to reduce risk of type 2 diabetes17.
Urinary Incontinence in those with Pre Diabetes and Type II Diabetes
Management lies in adopting a healthy lifestyle.
Although there are a number of risk factors responsible for the development of pre diabetes (a blood glucose level higher than normal, but not high enough to be diagnosed as Type II diabetes) and Type II diabetes, it is strongly associated with obesity. Obese people are 10 times more likely to develop Type II diabetes than a person of normal weight1, and account for 85% of all people with diabetes2.
Both pre diabetes (which may develop into Type II diabetes within 5-10 years if left untreated) and Type II diabetes are associated with urinary incontinence3. Furthermore, women who are overweight and have Type II diabetes have an increased risk of incontinence between 50-70%4.
In a 2005 study published by the American Diabetes Association of postmenopausal women, those with diabetes were more likely to experience severe and symptomatic urinary incontinence. Women in this study with diabetes ‘reported disproportionally more severe incontinence, difficulty controlling urination, mixed (stress and urge) incontinence, use of pads, inability to completely empty the bladder, being unaware of leakage and discomfort with urination’.5
The physiological changes associated with diabetes are thought to have an effect on urinary continence in a number of ways: Diabetic Cystopathy, a reduction in nerve function that occurs in diabetics can prevent them from sensing when their bladder is full, and the need to empty it. This may cause the bladder to become overstretched from urine volume6. It may also prevent the bladder from emptying completely causing overflow incontinence7. Increased thirst, a symptom of diabetes, results in drinking more fluids, causing more frequent and pressing need to urinate8.
Smith (2006) notes that ‘patients with diabetes and glucosuria (glucose in the urine) also have an increased risk of urinary tract infections that may exacerbate existing lower urinary tract
symptoms, including voiding and urge urinary incontinence’9.
Although there are specific measures to control pre diabetes and Type II diabetes (such as the oral anti diabetic drug metformin), these have not been shown to have an impact on incontinence10. There is however, evidence suggesting that a lifestyle change incorporating diet and increased exercise will help control these conditions as well as the resultant incontinence11.
A recent study conducted by JS Brown et al demonstrates that the prevalence of total weekly incontinence was lower among pre diabetic women who adopted a lifestyle change of exercise and diet over 3 years to those only taking metformin (oral antidiabetic drug prescribed to treat type
II diabetes) or placebo12.
The weight loss achieved by the group that exercised and dieted was particularly effective in reducing stress incontinence, and lowered participant’s risk of developing Type II diabetes.
While incontinence is a manageable condition, knowledge of how to avoid or reduce it may be a very powerful tool in motivating overweight and obese people with, or with a risk of pre diabetes and Type II diabetes to adopt a healthier lifestyle. This has positive outcomes on all aspects of health13 and may prevent the more serious effects that advanced diabetes has on incontinence.
Urinary Incontinence in those with Pre Diabetes and Type II Diabetes (Endnotes)
1 Australian Diabetes, Obesity and Lifestyle Report 2005, Ausdiab
2 Australian Diabetes, Obesity and Lifestyle Report 2005, Ausdiab
3 Jackson, S. et al. Urinary Incontinence and Diabetes in Post Menopausal Women, Diabetes Care 2005; 28:1730 -1738
4 Brown, J. Lifestyle Intervention Is Associated With Lower Prevalence of Urinary Incontinence, The Diabetes Prevention Program Diabetes Care 2006; 29:385-390.
5 Jackson, S. et al. 2005 Ibid
6 Seek Wellness website. Viewed 16 February 2007. www.seekwellness.com/conditions/diabetes/incontinence.htm
7 Seek Wellness website. Ibid
8 Seek Wellness website. Ibid
9 Smith, D. Urinary Incontinence and Diabetes: A Review, Journal Wound Ostomy and Continence Nurses Society 2006; 33(6): 619-623mith, D. 2006 ibid
10 Brown, J.Lifestyle Intervention Is Associated With Lower Prevalence
of Urinary Incontinence” The Diabetes Prevention Program Diabetes Care 2006; 29:385-390.
11 Brown, J. 2006 Ibid
12 Brown, J. 2006 Ibid
13 Brown, 2006 J. Ibid
14 Tasmanian Department of Health & Human Services Website. Viewed 28 February 2007. http://www.dhhs.tas.gov.au/healthyliving/diabetes/ 15 Australian Diabetes.