Urinary incontinence and voiding dysfunctionare common, chronic, and costly health problems in womenwith type 2 diabetes. Nearly 60% of women with diabetes report weekly incontinence and consider theirncontinence bothersome, and about 20% report that it interferes with their daily lives- two times moreSequent than incontinent women without diabetes. However, our understanding of the natural history,risk'actors of new onset and worsening symptoms, possible mechanisms, and interventions to prevent orreduceseverity of incontinence among women with type 2 diabetes is limited. The proposed prospective study will build upon the well-characterized Diabetes Reproductive Risks ofincontinence Study (RRISK). The Diabetes RRISK is a population-based ethnically diverse cohort of400women with type 2 diabetes that includes extensive assessment of lower urinary tract function by in-personinterview, self-report, chart abstraction, voiding diaries, post-void residual volumes, and in a sample,objective measures of bladder function including uroflow and urodynamics. In addition, the DiabetesRRISKincludes a broad range of diabetes measures such as duration, treatment, glycemic control, complications ofdiabetes, and laboratory data. With links to all laboratory, radiology, inpatient, outpatient, pharmacy, andsurgery Kaiser clinical databases, the study provides an unequalled level of detail. The proposed longitudinalDiabetes RRISK will follow the women for 5 years to determine risk factors for and new onset andincreasesin the severity of incontinence. The overarching goal of the proposed study is to advance our understanding of the natural historyandpathophysiology of incontinence in diabetic women. The linkage of our clinical study and the SCOR BasicMechanisms Project using a unique type 2 diabetes rat model will help us to understand the broader context ofincontinence and diabetic voiding dysfunction as well as characterize underlyingmolecular mechanisms.Ultimately, a deeper understanding of the epidemiology and pathophysiology of incontinence anddiabeticvoiding dysfunction in women with diabetes may be helpful in the developmentof new prevention andearlytreatment strategies for these conditions.
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