In 2021, the age-adjusted prevalence of diabetes among individuals aged 20-79 years in India was 9.6% (1). Globally, the estimated prevalence of lower urinary tract symptoms (LUTS) among adults is 50% (2)(3). The well-established fact is the adverse effect of diabetes on the bladder, which manifests in later stages as diabetic cystopathy.

Additional data to characterize the epidemiology and impacts of LUTS would enhance comprehension and ensure appropriate targeting of efforts to enhance diagnosis and treatment. 

Here, we present data from central India, aiming to offer deeper insights into the prevalence of LUTS in this region.

Primary objective: Determine the prevalence of LUTS among male patients aged 60 and above, distinguishing between diabetic and non-diabetic individuals.

Secondary objective: Explore the correlation between the duration of diabetes, glycemic control (measured by HbA1C levels), and the severity of LUTS.

Inclusion criteria- Patients with LUTS defined by IPSS, Male, age > 60.
Exclusion criteria- Patients with malignancy of the LUT, h/o prostate biopsy, h/o PUC, LUT infection, LUT surgery, cognitively impaired, urethral stricture, urolithiasis, on alpha blockers, type 1 DM.

Males above 60 year of age visiting urology OPD from September 2022 to July 2023 satisfying the inclusion criteria were included.
Prevalence of LUTS among diabetic and non-diabetic patients were assessed after dividing them in 2 cohorts based on their HbA1C levels and history of known DM-2.
Severity of LUTS was assessed using Hindi IPSS questionnaire.
Duration and control of diabetes (HbA1C) and its correlation with LUTS severity were assessed

Total Males above 60 years of age in the study period were 1388 out of which 209 (15%) were diabetics and 1179 (85%) were non-diabetic.
LUTS prevalence in diabetic and non-diabetic patients were 64.6 % and 42.2 % respectively.
IPSS of diabetics were found to be in the moderate to severe category as compared to non-diabetics.
Nocturia was the most common symptom among diabetic patients (80%).

Longer duration of DM2 was associated with increased severity of LUTS.(p value 0.010, CI 95%).
Higher HbA1c (uncontrolled DM-2) was associated with increased severity of LUTS. (p value <.001, CI 95%).

Understanding the prevalence of LUTS is crucial for estimating the associated healthcare workload and expenses required to manage this patient population effectively.

Diabetic cystopathy, despite being a well-defined condition, often develops insidiously and may remain asymptomatic until reaching an advanced stage. Patients typically do not exhibit symptoms unless specifically prompted. Therefore, it is imperative for physicians treating diabetic patients to inquire about symptoms related to LUTS, such as through the International Prostate Symptom Score (IPSS), to identify these individuals early. Early identification allows for the implementation of appropriate preventive measures to mitigate the progression into diabetic cystopathy and its consequential complications, such as recurrent urinary tract infections, upper urinary tract changes, chronic kidney disease, and urosepsis.

Furthermore, there is a pressing need for health education initiatives targeting both physicians and patients to enhance awareness and understanding of this condition.

1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, Pavkov ME, Ramachandaran A, Wild SH, James S, Herman WH, Zhang P, Bommer C, Kuo S, Boyko EJ, Magliano DJ. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022 Jan;183:109119. doi: 10.1016/j.diabres.2021.109119. Epub 2021 Dec 6. PMID: 34879977.
2. Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int 2009;104:352-60.
3. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006;50:1306-14.