Diabetes and the Risk of Acute Urinary Tract Infection Among Postmenopausal Women

Abstract

OBJECTIVE -To examine whether the presence of diabetes alters the risk of acute urinary tract infection (UTI) in postmenopausal women. RESEARCH DESIGN AND METHODS -A case-control study of the Group HealthCooperative of Puget Sound (GHC), a staff-model nonprofit health maintenance organization in Washington State, was conducted. Subjects were women aged 55-75 years who had been members of GHC for at least 1 year and who had had an acute symptomatic UTI within the preceding month. Laboratory files were used to identify women with a urine culture that grew Ն10 5 colonies of a urinary pathogen. Medical records were reviewed to confirm the presence of acute, clinically symptomatic UTI. Control subjects were randomly selected from the GHC enrollment file, screened to remove women with recent UTI, and frequency matched to cases by age within 2 years. An interviewer ascertained self-reported clinician-diagnosed diabetes. Diagnosis of diabetes was confirmed by the GHC diabetes registry. A subsample of women underwent measurement of postvoid residual bladder volume (n ϭ 748) and culture of vaginal flora (n ϭ 454).RESULTS -Of the 901 case and 913 control subjects, diabetes was reported in 13.1 and 6.8%, respectively. The health plan diabetes registry confirmed the diagnosis in 92% of women who self-reported the condition. The age-adjusted odds ratio (OR) for UTI in relation to selfreported clinician-diagnosed diabetes was 2.2 (95% CI 1.6 -3.0). Adjustment for frequency of sexual intercourse and history of UTI had little effect on this estimate. Compared with nondiabetic women, higher UTI odds were seen in subjects who used oral hypoglycemic agents (OR 2.9 [95% CI 1.7-5.1]) and insulin (2.6 [1.5-4.6]) but not in subjects with untreated diabetes or diabetes treated by lifestyle changes (1.3 [0.7-2.3]). No significant difference was seen in the OR for UTI in diabetic women with disease of shorter duration (Ͻ10 years, OR 1.9) or longer duration (Ն10 years, OR 2.6) or in relation to HbA 1c level. Similar microbiologic pathogens were seen in diabetic and nondiabetic women. No significant differences were seen by diabetes status in mean postvoid residual bladder volume or vaginal flora.CONCLUSIONS -Diabetes under pharmacologic treatment is associated with increased risk of clinically apparent UTI in postmenopausal women.

Urologic Complications of Diabetes

“…However, trials have not been performed in women with diabetes. Although previously suggested as possible risk factors, duration of diabetes or elevated HbA 1c levels have not been shown to increase the risk of UTI in recent studies (96,98).…”

“…In postmenopausal women, type 2 diabetes has been associated with a twofold increased risk for UTIs (98 -100). Additionally, women on treatment with oral hypoglycemics or insulin have a three-to fourfold higher risk of UTI, possibly indicating an association with severity of diabetes (98).…”

A clinical prediction rule for urinary tract infections in patients with type 2 diabetes mellitus in primary care

“…Studies show that 20-30% of women will have recurrent episodes during their lifetime [1]. Patients with diabetes mellitus (DM) have an increased risk of UTIs [2][3][4].…”

A Case of Pneumatosis Cystoides Intestinalis and Portal Venous Gas Accompanied by Emphysematous Pyelonephritis in Type 2 Diabetes Mellitus

“…EP is a severe necrotizing form of multifocal bacterial nephritis, and the prognosis is commonly poor. Therefore, early diagnosis, proper clinical and radiological assessment, and appropriate antibiotic therapy are necessary to improve prognosis [1]. Other diseases also were often combined with EP in diabetes mellitus.…”

“…Diabetes mellitus is a major risk factor for urinary tract infections (UTI) [1]. Emphysematous pyelonephritis (EP), a complication of UTI, is often found in patients with underlying, poorly controlled diabetes mellitus [2].…”