title: Epidemiology of urinary tract infections in type 2 diabetes mellitus patients: An analysis based on a large sample of 456,586 German T2DM patients.
abstract: BACKGROUND
  This analysis was conducted to investigate urinary tract infection (UTI) incidence among Type 2 Diabetes mellitus (T2DM) patients in Germany in a real-world setting and to identify risk factors associated with UTI incidence/recurrence.
  
  
  METHODS
  Our cohort study was conducted based on an anonymized dataset from a regional German sickness fund (2010-2012). A UTI event was mainly identified through observed outpatient/inpatient UTI diagnoses. We reported the number of UTI events per 1000 patient-years. Furthermore, the proportion of patients affected by ≥1 and ≥2 UTI events in the observational period was separately reported. Finally, three multivariate Cox regression analyses were conducted to identify factors that may be associated with UTI event risk or recurrent UTI event risk.
  
  
  RESULTS
  A total of 456,586 T2DM-prevalent patients were identified (mean age 72.8years, 56.1% female, mean Charlson Comorbidity Index (CCI) of 7.3). Overall, the UTI event rate was 87.3 events per 1000 patient-years (111.8/55.8 per 1000 patient-years for women/men (p<0.001)). The highest UTI event rates were observed for those aged >89years. After 730days after first observed T2DM diagnosis, the proportion of women/men still UTI-event-free was 80.9%/90.2% (p<0.001). Most important factors associated with UTI risk in our three models were older age (Hazard Ratio (HR)=1.56-1.70 for >79years), female gender (HR=1.38-1.57), UTIs in the previous two years (HR=2.77-5.94), number of comorbidities as measured by the CCI (HR=1.32-1.52 for CCI>6) and at least one cystoscopy in the previous year (HR=2.06-5.48). Furthermore, high HbA1c values in the previous year (HR=1.29-1.4 referring to HbA1c>9.5%) and a poor kidney function (HR=1.11-1.211 referring to glomerular filtration rate (GFR)<60ml/min) increased the UTI event risk.
  
  
  CONCLUSIONS
  Our study confirms that UTI event risk is high in T2DM patients. Older female patients having experienced previous UTIs face an above-average UTI risk, especially if these risk factors are associated with poor glycemic control and poor kidney function.
authors.affiliation: Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), University of Wismar, Germany. Electronic address: thomas.wilke@ipam-wismar.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wilke
authors.affiliation: Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), University of Wismar, Germany.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Boettger
authors.affiliation: Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), University of Wismar, Germany.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Berg
authors.affiliation: Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), University of Wismar, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Groth
authors.affiliation: Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), University of Wismar, Germany.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Mueller
authors.affiliation: Pharmerit, US.
authors.forename: Marc
authors.initials: M
authors.lastname: Botteman
authors.affiliation: Merck & Co., Inc., US.
authors.forename: Shengsheng
authors.initials: S
authors.lastname: Yu
authors.affiliation: AOK PLUS, Dresden, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fuchs
authors.affiliation: AOK PLUS, Dresden, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Maywald
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003558:Cystoscopy / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000517:prevention & control; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014552:Urinary Tract Infections / Q000453:epidemiology*
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: T2DM; Type 2 diabetes mellitus; UTI; UTI incidence; UTI risk; Urinary tract infections