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 2994 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%). 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 body mass index (BMI) of ≥ 35 kg/m² had a higher odds of overall and stress incontinence (55 to 85% higher; p <0.03) compared with non-obese. Risk factors for overall incontinence, as well as stress and urgency incontinence, included prior hysterectomy (40 to 80% increased risk; p < 0.01) and urinary tract infection in the prior year (55 to 90% increased risk; p < 0.001).

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