Nazzal Zaher, Khatib Batool, Al-Quqa Bayan, Abu-Taha Lina, Jaradat Ahmad
Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, occupied Palestinian territory.
Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, occupied Palestinian territory.
Lancet. 2021 Jul;398 Suppl 1:S42. doi: 10.1016/S0140-6736(21)01528-2.
Diabetes is one of the most common chronic illnesses worldwide, and it is increasing in prevalence. Urinary incontinence is another worldwide health problem, with a reported prevalence that ranges from 9% to 67%. It decreases quality of life for men and women and has been associated with many poor outcomes, such as longer hospital stays, recurrent or persistent urinary tract infection, and a higher mortality rate. Previous studies have suggested that diabetes is an independent risk factor for urinary incontinence. In addition, the patients' background and clinical characteristics such as age, obesity, and child-bearing history have been found to increase the risk. The aim of this study was to determine the prevalence of urinary incontinence in women with type 2 diabetes in the north West Bank and to assess the role of potential risk factors, including age, marital status, weight, and diabetes control.
Women with diabetes attending the six governmental primary health care centres in the north West Bank (Jenin, Tubas, Tulkarem, Nablus, Qalqilya, and Salfit) were interviewed using the CDC National Health and Nutrition Examination Survey (NHANES) standardised incontinence questionnaire. SPSS version 22 was used for data entry and analysis. The prevalence of urinary incontinence was estimated and differences between groups (variables of interest) were evaluated using the chi squared test. The study was approved by the Institutional Review Board of An-Najah National University, and permission to conduct the study was obtained from the Ministry of Health.
400 Palestinian women with diabetes were invited to participate in the study by convenience sampling, of whom 381 were recruited (a sample size that was chosen with a sample size formula, based on the population of the north West Bank). The participants were aged 30-83 years, and 44% (165 of 381; 95% CI 39-49) reported incontinence, regardless of the type. The prevalence of stress and urge incontinence were 34% (128) and 35% (133), respectively. 30% of women with urinary incontinence (49 of 165) reported that it did not affect their quality of life, and 34% (56 of 165) stated that it did not affect their daily activity. The presence or absence of urinary incontinence was studied in relation to the background and clinical variables by use of the chi squared test. The analysis showed a significant relationship between urinary incontinence status and age (p=0·0011), previous abdominal and genitourinary surgeries (p=0·0037), and caffeine consumption (p=0·041). There was no relationship between urinary incontinence and the duration, type of treatment, or complications of diabetes.
The prevalence of urinary incontinence (regardless of the type) is high among Palestinian women with diabetes. This is similar to reported prevalence in women with diabetes in neighbouring countries, such as Jordan (44%) and Qatar (21%). The majority of participants in this study (70%) reported that urinary incontinence did not affect their quality of life. This may suggest that patients consider the problem to be ordinary, that it does not require medical advice, or that the symptoms are mild. The findings highlight the importance of educating women with diabetes about urinary incontinence. The primary health care medical teams, general practitioners, and nurses who care for patients with diabetes should focus on this neglected problem, and physicians should be alert to urinary incontinence as it may often go unreported and therefore undertreated. To understand whether non-reporting of urinary incontinence reflects mild symptoms, investigating a potential association between non-reporting and the severity or frequency of urinary incontinence may be of interest for future study.
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糖尿病是全球最常见的慢性病之一，其患病率正在上升。尿失禁是另一个全球性的健康问题，报告的患病率在9%至67%之间。它会降低男性和女性的生活质量，并与许多不良后果相关，如住院时间延长、反复或持续的尿路感染以及更高的死亡率。先前的研究表明，糖尿病是尿失禁的一个独立危险因素。此外，患者的背景和临床特征，如年龄、肥胖和生育史，也被发现会增加风险。本研究的目的是确定约旦河西岸2型糖尿病女性的尿失禁患病率，并评估潜在危险因素的作用，包括年龄、婚姻状况、体重和糖尿病控制情况。
使用美国疾病控制与预防中心（CDC）国家健康和营养检查调查（NHANES）标准化失禁问卷，对在约旦河西岸六个政府初级卫生保健中心（杰宁、图巴斯、图勒凯尔姆、纳布卢斯、盖勒吉利耶、萨尔费特）就诊的糖尿病女性进行访谈。使用SPSS 22版本进行数据录入和分析。估计尿失禁的患病率，并使用卡方检验评估组间差异（感兴趣的变量）。本研究得到了纳贾赫国立大学机构审查委员会的批准，并获得了卫生部进行该研究的许可。
通过方便抽样邀请了400名巴勒斯坦糖尿病女性参与研究，其中381名被招募（样本量是根据约旦河西岸的人口，使用样本量公式选择的）。参与者年龄在30至83岁之间，44%（381名中的165名；95%可信区间39 - 49）报告有失禁情况，无论失禁类型如何。压力性尿失禁和急迫性尿失禁的患病率分别为34%（128名）和35%（133名）。30%的尿失禁女性（165名中的49名）报告说这没有影响她们的生活质量，34%（165名中的56名）表示这没有影响她们的日常活动。通过卡方检验研究尿失禁的有无与背景和临床变量的关系。分析显示尿失禁状态与年龄（p = 0.0011）、既往腹部和泌尿生殖系统手术（p = 0.0037）以及咖啡因摄入量（p = 0.041）之间存在显著关系。尿失禁与糖尿病的病程、治疗类型或并发症之间没有关系。
约旦河西岸患有糖尿病的巴勒斯坦女性中，尿失禁（无论类型）的患病率很高。这与邻国糖尿病女性报告的患病率相似，如约旦（44%）和卡塔尔（21%）。本研究中的大多数参与者（70%）报告说尿失禁没有影响她们的生活质量。这可能表明患者认为这个问题很平常，不需要医疗建议，或者症状很轻微。研究结果凸显了对糖尿病女性进行尿失禁教育的重要性。照顾糖尿病患者的初级卫生保健医疗团队、全科医生和护士应关注这个被忽视 的问题，医生应警惕尿失禁，因为它可能经常未被报告，因此未得到治疗。为了解尿失禁未报告是否反映症状轻微，研究未报告与尿失禁严重程度或频率之间的潜在关联可能是未来研究感兴趣的方向。
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