Relation between glycemic levels and low tract urinary symptoms in elderly

Abstract

Introduction: Due the low mortality attributed to BPH, the evaluation of the impacts of LUTS on quality of life of the patients has great importance, especially on the concern of therapeutic choices, except on cases of formal surgery indication. This increase is directly related with difficulties to perform ordinary tasks and a normal living in community.

Objectives: Determinate an association among Diabetes mellitus II and BPH symptoms in a group of elder men.

Methodology: This is an observational clinic trial, comparative. About 62 male subjects, 60 years old or more have been active interviewed. They were divided in two similarly groups. First was composed by men without diabetes and the second with diabetic men. For the evaluation of prostatic symptoms, it was utilized the IPSS.

Results: Mean age on Group I was 67.6 years old, while on Group II was 68.7 years old (p = 0.1521). After questionnaire, 51.5% of participants on Group I and 54.2% on Group II presented Systemic Arterial Hypertension (p = 0.099). IPSS was higher on group II (p < 0.0005).

Discussion: Diabetes mellitus was positively associated with the increasing of the LUTS, especially NOCTÚRIA. Patients on group I had a media of 14.2 points on IPSS questionnaire, while those on group II reached the media of 7 points. This pattern was the same even after the age, corporal mass and social/economic adjustment.

Conclusion: There is a statistically association between DM and LUTS on Elder men, evaluated through a specific questionnaire.

• Benign prostatic hyperplasia
• diabetes mellitus
• low urinary tract symptoms

Introduction

Brazil lives an increasing process of population aging, like developed countries, because the decline of fecundity and mortality levels [1]. It is also associated with the improvement of quality of life (living conditions, alimentation and life style) and the advance of scientific knowledge, witch propitiate an early diagnosis and treatment, as collaborate with the prevention of diseases due vaccines and medicines [1,2]. That leaves toward an alteration on the mortality profile of Brazilian population. So, while infection and parasite diseases are losing their previous spotlight, chronic non-transmissible diseases are the major causes of death among Brazilians [3,4].

Diabetes mellitus constitute one of the priority issues on public health, contributing for the increase of levels of hospitalization, incapacity and mortality. On Brazil, data from a multicentric study reveals that over five million of Brazilians have Diabetes, almost 8% of population among 30 and 69 years old and 2.7% under 30 years [5,6].

Benign Prostate Hyperplasia (BPH) and Low Urinary Tracts Symptoms (LUTS) are among the most common pathologies/symptoms the leads for morbidity in elder men [7–12]. Principal symptoms are arising from alteration of the bladder empty (weak urinary flow, intermittence, hesitance, micturition stress); others related with bladder storage: frequency, nocturia, urgency and urinary incontinence and, finally, those post micturition symptoms (incomplete empty and dripping) [7]. Furthermore, BPH symptoms can interfere on sleep quality and sexual function [11]. However, BPH is a disease with very low mortality rates, save in extreme conditions, with installed complications such as chronic kidney failure or urinary infections with sepsis [8–12].

For objective symptoms mensuration of the BPH, the International Prostate Symptoms Score (IPSS), is universally employed. It is a questionnaire validated for Portuguese, self-applicable, composed by questions that evaluate the frequency of seven different symptoms related with BPH, varying among 0 and 35 points [13,14].

This study aims to determinate an association among Diabetes mellitus ii and BPH symptoms on a group of elder men.

Methodology

This is an observational clinic trial, comparative, approved by Ethic Committee of São Paulo Federal University (CEP 0143/2009).

About 62 male subjects, with 60 years old or more, have been consecutively interviewed for this study. All men were recruited on Basics Health Unities of Capão da Canoa City, Rio Grande do Sul, Brazil, between January and December of 2010. All participants need, with no exception, comprehend and sign the consent form.

The inclusion criteria for this study were:

•  Men with 60 year old or more

•  Diagnosis of HPB and Diabetes mellitus II

•  Volunteered signed the informed consent

The adopted exclusion criteria were:

•  Antecedent of Radical Prostatectomy

•  Use of bladder catheter (any kind)

•  Presence of acute diseases or chronic disease in activity or in acute phase

•  Presence of malign neoplasms

•  Presence of neurologic and/or psychiatric diseases

•  Alcoholism or abuse of recreational drugs

• Use of one of those medicines: anxiolytics, anti-depressives, anti-seizures, anti-Parkinson’s, antipsychotics, mood stabilizer or anticholinergic.

The sample was calculated through statistical tests of t of student and through analysis of previews published trials. It was obtained the “n” of 62 subjects for right statistical validation. They were divided in two groups with 31 components each. First was composed by men without diabetes and the second with men with Diabetes mellitus II.

Data were obtained through active interview, done by the same interviewer, utilizing social and demographic questionnaires. For the evaluation of prostatic symptoms it utilized the IPSS (Table 1).

Table 1. International prostate symptom score (IPSS).

	Date:
Name:	Not at all	Less than 1 time in 5	Less than half the time	About half the time	More than half the time	Almost always	Your score
Incomplete emptying: Over the past month, how often have you had a sensation of not emptying your bladder completely after you finish urinating?	0	1	2	3	4	5
Frequency: Over the past month, how often have you had to urinate again <2 h after you finished urinating?	0	1	2	3	4	5
Intermittency: Over the past month, how often have you found you stopped and started again several times when you urinated?	0	1	2	3	4	5
Urgency: Over the last month, how difficult have you found it to postpone urination?	0	1	2	3	4	5
Weak stream: Over the past month, how often have you had a weak urinary stream?	0	1	2	3	4	5
Straining: Over the past month, how often have you had to push or strain to begin urination?	0	1	2	3	4	5
	None	1 time	2 times	3 times	4 times	5 times or more	Your score
Nocturia: Over the past month, many times did you most typically get up to urinate from the time you went to bed until the time you got up in the morning?	0	1	2	3	4	5
Total IPSS score
Quality of life due to urinary symptoms	Delighted	Pleased	Mostly satisfied	Mixed – about equally satisfied and dissatisfied	Mostly dissatisfied	Unhappy	Terrible
If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that?	0	1	2	3	4	5	6

Total score: 0–7, Mildly symptomatic; 8–19, moderately symptomatic; 20–35, severely symptomatic.

Statistical analysis was realized through the software SAS 9.1 (Statistical Analysis System Cary, NC) and Minitab 14.1 (State College, PA). Variable medians were compared among two independent groups utilizing t of Student’s test and chi-squared test. It was considered statistically relevant, values of p < 0.05.

Results

Mean age on Group I was 67.6 years old, while on Group II was 68.7 years old (p = 0.1521).

On this sample, there were a statistical difference about the glycemic levels between both groups (Group I: 95.4 mg/dL, Group II: 163.6 mg/dL), with p < 0.05.

Group I presented a higher IPSS grade (media: 23 points) when compared with group II (media: 16 points). Those results have a statistical significance, with p < 0.0005 (Table 2).

Table 2. IPSS questionnaire.

	Group I	Group II
Sample (n)	31	31
Lower grade	0	0
Higher grade	23	16
Media (SD)	14.12 (±8.02)	7.32 (±8.85)

p < 0.0005.

Discussion

Due the low mortality attributed to BPH, the evaluation of the impacts of LUTS on quality of life of the patients has great importance, especially on the concern of therapeutic choices, except on cases of formal surgery indication.

Despite the aging process’ not been, necessarily related with diseases or incapacities, chronic and degenerative diseases are often found among Elder population. Therefore, the current tendency is the increase of the number of patients with such condition. This increase is directly related with difficulties to perform ordinary tasks and a normal living in community.

Some authors have found that the control of weight and the performance of any physical activity lead to a diminished insulin resistance, decreasing the odds for the development of Diabetes mellitus.

According the literature, diabetics have twice the chance to present arterial hypertension the general population. Generally, this kind of patient has a higher incidence of coronary disease, peripheral arterial disease and brain vascular disease. Such condition can lead to other types of neuropathies, including autonomic dysfunction and sexual dysfunction.

Diabetes mellitus was positively associated with the increasing of the LUTS, especially nocturia. Patients on group I had a media of 14.2 points on IPSS questionnaire, while those on group II reached the media of 7 points. This pattern was the same even after the age, corporal mass and social/economic adjustment.

We demonstrated a statistically association (p < 0.05) between DM and LUTS on Elder men, evaluated through a questionnaire usually applied for evaluation of urinary symptoms.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.