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Hemoglobin Levels Linked to Severity of Incontinence in Older Women

Sei Lee, MD, Assistant Professor of Geriatrics at the University of California in San Francisco, and colleagues found that in older women in diabetes and urinary incontinence, very high hemoglobin A1c (HbA1C) levels are associated with patient reports of more severe limitations due to incontinence.  The data also showed, however, that in older women with diabetes, poor glycemic control does not predict the presence or absence of urinary incontinence.  The results were reported at the 71st Scientific Sessions of the American Diabetes Association.

They analyzed a large, diverse cohort of older women enrolled in the Diabetes and Aging Study, which is sponsored by the National Institutes of Health.  This five-year study examines medical care and outcomes in roughly 112,000 type 2 patients who are aged 59 years and older and enrolled in the Kaiser Permanente California Diabetes Registry.

Glycosuria has long been known to result from hyperglycemia.  Previous studies that have examined the relationship between poor glycemic control and urinary incontinence have found no association, but these studies included few patients with poor glycemic control and thus have had limited statistical power.

The outcome variables measured in this study were the presence/absence of incontinence and the severity of limitations due to incontinence.  The patients were asked “Do you experience occasional accidental urine leakage?” and “During the past 12 months, how much did the leakage of urine affect your day-to-day activities?”  The patients had the options of responding, “not at all,” “slightly,” “moderately,” “quite a bit,” or “extremely.”

The results from 3,916 older women with diabetes and urinary incontinence showed that HbA1C did not predict the presence or absence of urinary incontinence, after adjusting for age, ethnicity, education, income, parity, diabetes duration, diabetes treatment, co-morbid conditions, and body mass index.  Diabetic women with very poor control with an HbA1C greater than nine percent were about 50% more likely to be more severely limited by incontinence than women with excellent control with an HbA1C below six percent.  Dr. Lee recommended that clinicians routinely ask older female patients about incontinence.

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