Urinary incontinence, lower urinary tract symptoms and sexual dysfunction are common health problems that reduce quality of life and markedly increase in prevalence and incidence with advancing age. Earlier onset and increased severity of those conditions among men and women with diabetes result in costly and debilitating symptoms. However, data to define incidence, associated factors and interventions to reduce the risk of developing these complications among men and women with type 1 diabetes (T1D) are limited. We have assembled a multidisciplinary team to implement an ancillary study to the Epidemiology of Diabetes Intervention and Complication (EDIC) study, a major ongoing NIDDK research study. The collection of additional survey information from EDIC participants, combined with existing and new biological specimens, will repurpose this important study to measure the new onset of urological symptoms during an important window of time in which the frequency of urological complications is accelerating. Our hypothesis is that urological complications of diabetes impair quality of life (QOL) and that diabetic and systemic factors can be identified that predict men and women at risk for these complications.
Our specific aims are to 1) measure the onset and progression of urinary incontinence (UI), lower urinary tract symptom severity (LUTS), and sexual dysfunction (SDF) in men and women with T1D and determine the influence of glycemic therapy and diabetes severity on these complications;2) determine the influence of low testosterone levels and prostate growth on the associations between glycemic therapy, diabetes severity and the complications of LUTS and SDF in men and 3) measure the impact of the onset and progression of urologic complication on health related QOL I men and women with T1D. The timing of this study is critical in order to capture the upswing in incidence of urological complications as the EDIC cohort reaches 50 years of age. The completion of these aims will provide comprehensive insight into the association between urologic complication and T1D and the impact of these symptoms on QOL. Predictive and protective factors will be identified that map out strategies for intervention and prevention studies. Findings from this proposal may also reveal important relationships between diabetic factors and ageing, bladder and prostate biology, and provide a data repository for biomarker discovery and genome wide association studies. Public Health Relevance: (adapted from the application) The proposed study is likely to offer an opportunity to complete important investigations on urological complications of type 1diabetes by repurposing the DCCT/EDIC parent study and its established cohorts. The collection of additional survey information from recruited study participants is likely to give a one-time chance to capture incident urological complications and the impact of these conditions on quality of life. The precise data from this study will be important to educate patients and their families, help develop biomarkers of urological complications and provide refined phenotypes for genetic susceptibility studies.

Public Health Relevance

Urological complications of diabetes including urinary incontinence, lower urinary tract symptoms and sexual dysfunction are progressive disorders of the genitourinary tract that collectively affect millions of American men and women. The increasing prevalence of diabetes and aging of the US population will impart a significant burden of urological complications on the health care system due to early onset, symptom severity and associated reductions in quality of life. Strategies to prevent or intervene in these conditions require accurate understanding of disease mechanisms, predictors and protective factors. UroEDICII offers the unique opportunity to complete important investigations on urological complications of type 1diabetes by repurposing the DCCT/EDIC parent study and its established cohorts. The collection of additional survey information from recruited study participants gives us a one-time chance to capture incident urological complications and the impact of these conditions on quality of life. The precise data from this proposal will be important to educate patients and their families, help develop biomarkers of urological complications and provide refined phenotypes for genetic susceptibility studies.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK083927-04
Application #
8305070
Study Section
Special Emphasis Panel (ZDK1-GRB-7 (M3))
Program Officer
Kirkali, Ziya
Project Start
2009-09-25
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
4
Fiscal Year
2012
Total Cost
$513,604
Indirect Cost
$53,880
Name
University of Washington
Department
Urology
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Holt, Sarah K; Lopushnyan, Natalya; Hotaling, James et al. (2014) Prevalence of low testosterone and predisposing risk factors in men with type 1 diabetes mellitus: findings from the DCCT/EDIC. J Clin Endocrinol Metab 99:E1655-60
Wessells, Hunter; Penson, David F; Cleary, Patricia et al. (2011) Effect of intensive glycemic therapy on erectile function in men with type 1 diabetes. J Urol 185:1828-34