Prevalence and Risk Factors for Urinary Incontinence in Overweight and Obese Diabetic Women

doi:10.2337/dc09-0516

Prevalence and Risk Factors for Urinary Incontinence in Overweight and Obese Diabetic Women

Action for Health in Diabetes (Look AHEAD) study

Suzanne Phelan, PHD¹,
Alka M. Kanaya, MD²,
Leslee L. Subak, MD³,
Patricia E. Hogan, MS, MPH⁴,
Mark A. Espeland, PHD⁴,
Rena R. Wing, PHD⁵,
Kathryn L. Burgio, PHD⁶,
Vicki DiLillo, PHD⁷,
Amy A. Gorin, PHD⁸,
Delia S. West, PHD⁹ and
Jeanette S. Brown, MD³ the Action for Health in Diabetes (Look AHEAD) Research Group*

¹Kinesiology Department, California Polytechnic State University, San Luis Obispo, California;
²Department of General Internal Medicine, University of California San Francisco (UCSF), San Francisco Veterans Affairs Medical Center, San Francisco, California;
³Departments of Obstetrics, Gynecology and Reproductive Sciences, Urology and Epidemiology, UCSF Women's Health Clinical Research Center, San Francisco, California;
⁴Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina;
⁵Department of Psychiatry and Human Behavior, Brown Medical School, The Miriam Hospital, Providence, Rhode Island;
⁶University of Alabama at Birmingham and Department of Veterans Affairs, Birmingham, Alabama;
⁷Department of Psychology, Ohio Wesleyan University, Delaware, Ohio;
⁸Department of Psychology, Center for Health, Intervention, and Prevention, University of Connecticut, Storrs, Connecticut;
⁹Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Corresponding author: Suzanne Phelan, sphelan{at}calpoly.edu.

Abstract

OBJECTIVE To determine the prevalence and risk factors for urinary incontinence among different racial/ethnic groups of overweight and obese women with type 2 diabetes.

RESEARCH DESIGN AND METHODS Cross-sectional analysis of baseline data from the Action for Health in Diabetes (Look AHEAD) study, a randomized clinical trial with 2,994 overweight/obese women with type 2 diabetes.

RESULTS Weekly incontinence (27%) was reported more often than other diabetes-associated complications, including retinopathy (7.5%), microalbuminuria (2.2%), and neuropathy (1.5%). The prevalence of weekly incontinence was highest among non-Hispanic whites (32%) and lowest among African Americans (18%), and Asians (12%) (P < 0.001). Asian and African American women had lower odds of weekly incontinence compared with non-Hispanic whites (75 and 55% lower, respectively; P < 0.001). Women with a BMI of ≥35 kg/m² had a higher odds of overall and stress incontinence (55–85% higher; P < 0.03) compared with that for nonobese women. Risk factors for overall incontinence, as well as for stress and urgency incontinence, included prior hysterectomy (40–80% increased risk; P < 0.01) and urinary tract infection in the prior year (55–90% increased risk; P < 0.001).

CONCLUSIONS Among overweight and obese women with type 2 diabetes, urinary incontinence is highly prevalent and far exceeds the prevalence of other diabetes complications. Racial/ethnic differences in incontinence prevalence are similar to those in women without diabetes, affecting non-Hispanic whites more than Asians and African Americans. Increasing obesity (BMI ≥35 kg/m²) was the strongest modifiable risk factor for overall incontinence and stress incontinence in this diverse cohort.

Footnotes

↵*A complete list of the members of the Action for Health in Diabetes (Look AHEAD) Research Group can be found in an online appendix available at http://care.diabetesjournals.org/cgi/content/full/dc09-0516/DC1.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
- Received March 16, 2009.
- Accepted May 12, 2009.
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