1Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
2Biostatistics Center, George Washington University, Rockville, MD.
Diabetes Care. 2022 Jan 1;45(1):119-126. doi: 10.2337/dc21-1276.
To evaluate associations between diabetic peripheral neuropathy (DPN) and urological complications in men and women with type 1 diabetes (T1D).
Measurements of DPN at Epidemiology of Diabetes Intervention and Complications (EDIC) years 1, 14, and 17 and urological complications at EDIC year 17 were examined in 635 men (mean age 51.6 years, diabetes duration 29.5 years) and 371 women (mean age 50.6 years, diabetes duration 29.8 years) enrolled in the Diabetes Control and Complications Trial (DCCT)/EDIC study. DPN was defined by symptoms, signs, and abnormal electrophysiology or by abnormal Michigan Neuropathy Screening Instrument (MNSI) examination or questionnaire scores.
Erectile dysfunction (ED) in combination with lower urinary tract symptoms (LUTS) was reported in 15% of men and female sexual dysfunction (FSD), LUTS, and urinary incontinence (UI) in 16% of women. Adjusted for age, drinking status, BMI, depression, DCCT/EDIC time-weighted mean HbA1c, microalbuminuria, hypertension, triglycerides, and statin medication use, the odds of reporting ED and LUTS versus no ED or LUTS at EDIC year 17 were 3.52 (95% CI 1.69, 7.31) times greater in men with confirmed DPN at EDIC year 13/14 compared to men without confirmed DPN. Compared to men without DPN, men with DPN based on abnormal MNSI examination or questionnaire scores had significantly higher odds of reporting ED and LUTS versus no ED or LUTS at EDIC year 17. There were no significant differences in DPN between women reporting both FSD and LUTS/UI compared with those without FSD or LUTS/UI at EDIC year 17.
In long-standing T1D, DPN is associated with the later development of urological complications in men.
评估 1 型糖尿病（T1D）男性和女性患者的糖尿病周围神经病变（DPN）与泌尿系统并发症之间的关联。
在参加糖尿病控制与并发症试验（DCCT）/EDIC 研究的 635 名男性（平均年龄 51.6 岁，糖尿病病程 29.5 年）和 371 名女性（平均年龄 50.6 岁，糖尿病病程 29.8 年）中，分别于 EDIC 年 1、14 和 17 时测量 DPN，并在 EDIC 年 17 时测量泌尿系统并发症。DPN 通过症状、体征和异常电生理学或异常密歇根神经病变筛查工具（MNSI）检查或问卷评分来定义。
15%的男性报告存在勃起功能障碍（ED）合并下尿路症状（LUTS），16%的女性报告存在女性性功能障碍（FSD）、LUTS 和尿失禁（UI）。调整年龄、饮酒状况、BMI、抑郁、DCCT/EDIC 时间加权平均 HbA1c、微量白蛋白尿、高血压、甘油三酯和他汀类药物使用后，与 EDIC 年无 ED 或 LUTS 的男性相比，EDIC 年 13/14 时确诊为 DPN 的男性报告 ED 和 LUTS 的比值比为 3.52（95%CI 1.69，7.31）。与无 DPN 的男性相比，EDIC 年时 MNSI 检查或问卷评分异常的男性报告 ED 和 LUTS 的比值比明显更高，而无 ED 或 LUTS。与 EDIC 年无 FSD 或 LUTS/UI 的女性相比，EDIC 年报告 FSD 和 LUTS/UI 的女性之间的 DPN 无显著差异。
在长期的 T1D 中，DPN 与男性泌尿系统并发症的后期发生有关。
