title: Cardiovascular Autonomic Neuropathy, Sexual Dysfunction, and Urinary Incontinence in Women With Type 1 Diabetes.
abstract: This study evaluated associations among cardiovascular autonomic neuropathy (CAN), female sexual dysfunction (FSD), and urinary incontinence (UI) in women with type I diabetes mellitus (T1DM).
  
  
  
  We studied 580 women with T1DM in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC). CAN was defined as: 1) R-R variation <15 with deep breathing or 2) R-R variation of 15-19.9 plus Valsalva ratio ≤1.5 or a supine-to-standing drop of 10 mmHg in diastolic blood pressure. A Sandvik Severity Index of 3-12 defined UI, and a Female Sexual Function Index (FSFI-R) score ≥22.75 defined FSD. Multivariable models estimated associations among CAN, FSD, and UI.
  
  
  
  At EDIC year 17, FSD was observed in 41% of women and UI in 30%. No statistically significant associations were observed between measures of CAN at DCCT closeout and subsequent report of FSD or UI. At EDIC year 16/17, there was a 53% increased odds of having UI with a Valsalva ratio ≤1.5. At both EDIC year 13/14 and EDIC year 16/17, a 5-unit increase in R-R variation was associated with a 1.11 greater odds of having FSD.
  
  
  
  In women with T1DM in the DCCT/EDIC, we found significant increased odds of FSD and UI with specific measures of CAN. In long-standing T1DM, CAN may predict development of FSD and may be a useful surrogate for generalized diabetic autonomic neuropathy.
authors.affiliation: Department of Surgery (Urology), University of Utah, Salt Lake City, UT jim.hotaling@hsc.utah.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: Hotaling
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Sarma
authors.affiliation: Department of Surgery (Urology), University of Utah, Salt Lake City, UT.
authors.forename: Darshan P
authors.initials: DP
authors.lastname: Patel
authors.affiliation: Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Braffett
authors.affiliation: Biostatistics Center, George Washington University, Rockville, MD.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cleary
authors.affiliation: Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Eva
authors.initials: E
authors.lastname: Feldman
authors.affiliation: Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.affiliation: Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Martin
authors.affiliation: Research Institute, Winthrop University Hospital, Mineola, NY.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Jacobson
authors.affiliation: Department of Urology and Diabetes Endocrinology Research Center, University of Washington, Seattle, WA.
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
authors.affiliation: Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Rodica
authors.initials: R
authors.lastname: Pop-Busui
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002319:Cardiovascular System / Q000294:innervation*; D048909:Diabetes Complications / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003929:Diabetic Neuropathies / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology*; D014549:Urinary Incontinence / Q000453:epidemiology*; D014636:Valsalva Maneuver