title: Lifestyle intervention is associated with lower prevalence of urinary incontinence: the Diabetes Prevention Program.
abstract: OBJECTIVE
  Diabetes is associated with increased urinary incontinence risk. Weight loss improves incontinence, but exercise may worsen this condition. We examined whether an intensive lifestyle intervention or metformin therapy among overweight pre-diabetic women was associated with a lower prevalence of incontinence.
  
  
  METHODS
  We analyzed data from the Diabetes Prevention Program, a randomized controlled trial in 27 U.S. centers. Of the 1,957 women included in this analysis, 660 (34%) were randomized to intensive lifestyle therapy, 636 (32%) to metformin, and 661 (34%) to placebo with standard lifestyle advice. The main outcome measure was incontinence symptoms by frequency and type by a validated questionnaire completed at the end-of-trial visit (mean 2.9 years).
  
  
  RESULTS
  The prevalence of total (stress or urge) weekly incontinence was lower among women in the intensive lifestyle group (38.3%) than those randomized to metformin (48.1%) or placebo (45.7%). This difference was most apparent among women with stress incontinence (31.3% for intensive lifestyle group vs. 39.7% for metformin vs. 36.7% for placebo, P = 0.006). Changes in weight accounted for most of the protective effect of the intensive lifestyle intervention on stress incontinence.
  
  
  CONCLUSIONS
  Less-frequent urinary incontinence may be a powerful motivator for women to choose lifestyle modification to prevent diabetes.
authors.affiliation: Diabetes Prevention Program Research Group, The Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA. dppmail@biostat.bsc.gwu.edu
authors.forename: Jeanette S
authors.initials: JS
authors.lastname: Brown
authors.forename: Rena
authors.initials: R
authors.lastname: Wing
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: Leroy M
authors.initials: LM
authors.lastname: Nyberg
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Orchard
authors.forename: Yong
authors.initials: Y
authors.lastname: Ma
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Alka M
authors.initials: AM
authors.lastname: Kanaya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D004032:Diet; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008019:Life Style; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000517:prevention & control*; D015431:Weight Loss
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin