title: Long-term prevalence and predictors of urinary incontinence among women in the Diabetes Prevention Program Outcomes Study.
abstract: OBJECTIVE
  To examine the long-term prevalence and predictors of weekly urinary incontinence in the Diabetes Prevention Program Outcomes Study, a follow-up study of the Diabetes Prevention Program randomized clinical trial of overweight adults with impaired glucose tolerance.
  
  
  METHODS
  This analysis included 1778 female participants of the Diabetes Prevention Program Outcomes Study who had been randomly assigned during the Diabetes Prevention Program to intensive lifestyle intervention (n = 582), metformin (n = 589) or placebo (n = 607). The study participants completed semi-annual assessments after the final Diabetes Prevention Program visit and for 6 years until October 2008.
  
  
  RESULTS
  At the study entry, the prevalence of weekly urinary incontinence was lower in the intensive lifestyle intervention group compared with the metformin and placebo groups (44.2% vs 51.8%, 48.0% urinary incontinence/week, P = 0.04); during the 6-year follow-up period, these lower rates in intensive lifestyle intervention were maintained (46.7%, 53.1%, 49.9% urinary incontinence/week; P = 0.03). Statistically adjusting for urinary incontinence prevalence at the end of the Diabetes Prevention Program, the treatment arm no longer had a significant impact on urinary incontinence during the Diabetes Prevention Program Outcomes Study. Independent predictors of lower urinary incontinence during the Diabetes Prevention Program Outcomes Study included lower body mass index (odds ratio 0.988, 95% confidence interval 0.982-0.994) and greater physical activity (odds ratio 0.999, 95% confidence interval 0.998-1.000) at the Diabetes Prevention Program Outcomes Study entry, and greater reductions in body mass index (odds ratio 0.75, 95% confidence interval 0.60-0.94) and waist circumference (odds ratio 0.998, 95% confidence interval 0.996-1.0) during the Diabetes Prevention Program Outcomes Study. Diabetes was not significantly related to urinary incontinence.
  
  
  CONCLUSIONS
  Intensive lifestyle intervention has a modest positive and enduring impact on urinary incontinence, and should be considered for the long-term prevention and treatment of urinary incontinence in overweight/obese women with glucose intolerance.
authors.affiliation: Kinesiology Department, California Polytechnic State University, San Luis Obispo, California, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Phelan
authors.forename: Alka M
authors.initials: AM
authors.lastname: Kanaya
authors.forename: Yong
authors.initials: Y
authors.lastname: Ma
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: Rena
authors.initials: R
authors.lastname: Wing
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Orchard
authors.forename: Jill P
authors.initials: JP
authors.lastname: Crandall
authors.forename: Maria G
authors.initials: MG
authors.lastname: Montez
authors.forename: Jeanette S
authors.initials: JS
authors.lastname: Brown
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008019:Life Style; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Diabetes Prevention Program Outcomes Study; lifestyle intervention; urinary incontinence; weight loss