title: Glycemic control and urinary incontinence in women with diabetes mellitus.
abstract: BACKGROUND
  Although many studies have shown that diabetes increases the risk for urinary incontinence, it is unclear whether poor glycemic control in women with diabetes is associated with incontinence. This study aims to determine the relationship between the hemoglobin A1c (HbA1c) level and urinary incontinence in a large, diverse cohort of older women.
  
  
  METHODS
  We examined 6026 older women who responded to a survey (62% response rate) and were enrolled in the Diabetes and Aging Study, an ethnically stratified random sample of patients with diabetes enrolled in Kaiser Permanente Northern California. Our primary independent variable was the mean of all HbA1c measurements in the year preceding the survey. Outcomes included the presence/absence of incontinence and limitations in daily activities due to incontinence. We used modified Poisson regression and ordinal logistic regression models to account for age, race, body mass index, parity, diabetes treatment, duration of diabetes, and comorbidity.
  
  
  RESULTS
  Sixty-five percent of women reported incontinence (mean age 59±10 years). After adjustment, HbA1c levels were not associated with the presence or absence of incontinence. However, among women reporting incontinence, HbA1c ≥9% was associated with more limitations due to incontinence than HbA1c <6% (adjusted odds ratio 1.67, 95% confidence interval: 1.09-2.57).
  
  
  CONCLUSIONS
  In this cross-sectional analysis, HbA1c level is not associated with the presence or absence of incontinence. However, for women with incontinence, poor glycemic control (HbA1c ≥9%) is associated with more limitations in daily activities due to incontinence. Longitudinal studies are needed to determine whether improving glycemic control to HbA1c <9% leads to fewer limitations in daily activities due to incontinence.
authors.affiliation: 1 Division of Geriatrics, University of California-San Francisco , San Francisco, California.
authors.forename: Sei J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Julie N
authors.initials: JN
authors.lastname: Thai
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van Den Eeden
authors.forename: Elbert S
authors.initials: ES
authors.lastname: Huang
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012959:Socioeconomic Factors; D014549:Urinary Incontinence / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
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