Effect of Glycemic Control on the Clinical and Laboratory Profile of UTI in Patients with Diabetes Mellitus

Abstract

Introduction: Urinary Tract Infection is the commonest infection in the patients of Diabetes Mellitus. Glycemic control, which is a major goal in the management of DM, may have an effect on their clinical profile and investigations. In this study, we compared the clinical and laboratory profile of UTI in patients of DM having good glycemic control with those having poor glycemic control. Material and Methods: This was a prospective observational study in the patients admitted in Department of General Medicine in a tertiary care centre in Central India between January 2017 and September 2018. A total of 100 consecutive patients of DM with culture positive UTI were included in the study. Results: Out of the 100 patients, 44% were males and 56% were females; 10% had Type 1 DM and 90% had Type 2 DM; and 57% had good glycemic control, whereas 43% had poor glycemic control. Patients on Oral Hypoglycemic Agents had better glycemic control (68.1%) than those on Insulin (26.3%) [P = 0.002]. 'Adherence to treatment' (85.9%) and 'regular follow up' (71.9%) were attributes of patients with good control [P < 0.001]. Commonest symptom seen was Dysuria (62%). Urinary incontinence (15%) [P = 0.001] and renal angle tenderness (14%) [P = 0.03] were significantly commoner in the poor glycemic control group. Escherichia coli was the commonest isolate in urine culture (70%). E.coli and other Gram Negative Bacilli were most susceptible to Aminoglycosides (72% and 83%) whereas Gram Positive Cocci were most susceptible to Nitrofurantoin (100%). Resistance to Ampicillin was uniformly high. Conclusion: Glycemic control was better in those patients who adhered to treatment and had regular follow-up. Urinary incontinence and renal angle tenderness were associated with poor glycemic control. E.coli was the commonest isolate and Amikacin, Ceftriaxone and Nitrofurantoin were the most useful antibiotics.

Prevalence of urinary tract infections and risk factors among diabetic patients in Ethiopia, a systematic review and meta-analysis

“…The pooled prevalence of UTI among diabetes was 15.97% (95% CI: 12.72-19.23; I 2 = 87.85%). The reason for such high prevalence of UTI in diabetic patients, the researchers inferred that the relation between UTI and diabetes was associated with poor circulation, decreased immune system due to reduced ability of white blood cells to fight infections, poor contractions of the bladder leading to bladder dysfunction are some of the contributing factors leading to increased cases of UTI in diabetics [44][45][46].…”

The occurrence of urinary tract infection and determinant factors among diabetic patients at Dessie Referral Hospital, South Wollo, Northeast Ethiopia

“…5 The correlation between the occurrence of UTIs and diabetic patients has been attributed to various impairments in the body defense mechanism, poor metabolic control of DM, and incomplete bladder emptying due to autonomic neuropathy. 6…”

“…5 The correlation between the occurrence of UTIs and diabetic patients has been attributed to various impairments in the body defense mechanism, poor metabolic control of DM, and incomplete bladder emptying due to autonomic neuropathy. 6 Globally, 150 million people are diagnosed with UTIs yearly. 7 Among diabetic patients, 40% of the years of life lost can be attributed to nonvascular conditions like cancers, infections, and neurodegenerative disorders.…”

A Study On Clinical Profile of Urinary Tract Infection in Diabetes Mellitus in a Tertiary Care Hospital

“…However, in our study incidence of UTI was found to be more in diabetics who were taking OHA than insulin. In a prospective observational study conducted by Sylvester JS et al, 10 out of the 100 diabetics with UTI 43% had poor glycaemic control, patients on OHA had better glycaemic control than those on insulin and UTI was commonly seen with poor glycaemic control group. However, in our study 3.1% % incidence of UTI was found to be higher in diabetics who were taking OHA compared to patients on insulin.…”