Diyabetik hastalarda alt üriner sistem fonksiyonlarının araştırılması
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Dosyalar
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Diabetes mellitus, prevalansı her geçen gün artan ve yaygın komplikasyonlara
neden olan önemli bir sağlık sorunudur. Sistemik bir hastalık olması nedeniyle alt
üriner sistem üzerine de birçok olumsuz etkisi vardır. Bu hastalık çeşitli patofizyolojik
etki mekanizmalarıyla, oldukça geniş bir yelpazede bulunan obstrüktif ve irritatif alt
üriner sistem semptomlarına neden olmaktadır. Bu semptomların şiddet ve
sıklığındaki değişikliklerin diyabetin kendisi ve kronik komplikasyonları ile ilişkili
olduğu düşünülmektedir. Çalışmamızda diyabete bağlı gelişen metabolik
değişikliklerin ve kronik komplikasyonların alt üriner sistem fonksiyonlarını ne ölçüde
ve ne şekilde etkilediğini araştırmayı amaçladık.
Çalışmamıza Ocak 2013 ile Ocak 2016 tarihleri arasında Ege Üniversitesi Tıp
Fakültesi Endokrinoloji Bilim Dalı’nda tip 1 veya tip 2 diabetes mellitus tanısı ile takip
edilen rastgele seçilmiş 100 erişkin hasta dahil edildi ve hastalar retrospektif olarak
değerlendirildi. Hastaların yaş, cinsiyet, diyabet tipi, diyabet süresi, diyabetle ilişkili ek
hastalık durumu, diyabete bağlı bir komplikasyon nedeniyle geçirilmiş cerrahi
durumu, vücut kitle indeksi (VKİ), açlık plazma glukoz (APG) seviyesi, HbA1c
seviyesi, GFR değeri, serum D vitamini düzeyi, nöropati durumu, retinopati durumu,
üroflovmetri ölçüm değerleri, PVR miktarı, IPSS skoru, ICIQ-SF skoru ve OAB-Q SF
skoru kaydedildi.
Hastaların 62’si (%62) kadın 38’i (%38) erkek cinsiyete sahipti. Hastaların 27’si
(%27) tip 1 diyabet, 73’ü (%73) tip 2 diyabet tanısına sahipti. Hastaların ortalama yaşı
50.5±16.6, ortalama VKİ değeri 28.5±8.3 kg/m², ortalama diyabet süresi 13.2±9.2 yıl,
ortalama APG seviyesi 172.3±73.9 mg/dl, ortalama HbA1c seviyesi % 8.8±2.4,
ortalama GFR değeri 110.5±43.2 ml/dk/1.73m² ve ortalama serum D vitamini seviyesi
25.4±26.4 nmol/L olarak saptandı.
Hastaların 59’unda (%59) diyabetik nöropati, 38’inde (%38) diyabetik retinopati
olduğu görüldü. Hastalara ait toplanan tüm veriler üroflovmetri değerleri, PVR miktarı,
IPSS skoru, ICIQ-SF skorları ve OAB-Q SF skorları ile karşılaştırılarak istatistiksel
analiz yapıldı.
Yapılan analizler sonucunda diyabetik nöropatinin ortalama idrar akım hızında
azalma (p=0,0002), ICIQ-SF toplam skorda artma (p=0,015), ICIQ-SF idrar kaçırma
miktarı skorunda artma (p=0,031), ICIQ-SF hayat kalitesi skorunda artma (p=0,038),
OAB-Q SF semptom şiddeti skorunda artma (p=0,022) ve OAB-Q SF hayat kalitesi skorunda azalma (p=0,003) ile anlamlı olarak ilişkili olduğu görülmüştür. Ayrıca
diyabetik nefropatinin ICIQ-SF toplam skorda artma (p=0,02) ve ICIQ-SF hayat
kalitesi skorunda artma (p=0,011) ile anlamlı olarak ilişkisi gösterilmiştir. Bununla
beraber HbA1c seviyesinde yükselmenin OAB-Q SF hayat kalitesi skorunda düşme
ile anlamlı ilişkisi gösterilmiştir (p=0,026). D vitamini eksikliğinin artmış PVR miktarı
ile anlamlı olarak ilişkili olduğu saptanmıştır (p=0,006). Diyabete bağlı bir
komplikasyon nedeniyle cerrahi geçirenlerde ortalama idrar akım hızının anlamlı
olarak düşük olduğu (p=0,01) ve işeme disfonksiyonunun daha sık görüldüğü
(p=0,006) gösterilmiştir. Yine tip 2 diyabette ortalama idrar akım hızlarının daha
düşük olduğu (p=0,003) ve PVR miktarının daha yüksek olduğu (p=0,047)
saptanmıştır. Bunların yanında erkek cinsiyette OAB-Q SF hayat kalitesi skorunun
anlamlı olarak daha düşük olduğu görülmüştür (p=0,035). Son olarak ileri yaşlı grupta
OAB-Q SF semptom şiddeti skoru anlamlı olarak daha yüksek bulunmuşken
(p=0,007) OAB-Q SF hayat kalitesi skoru daha düşük bulunmuştur (p=0,002).
Çalışmamızdan elde edilen sonuçlara göre diyabetik hastalarda alt üriner
sistem fonksiyonlarını etkileyen faktörler; diyabetik nöropati varlığı, evre 3 ve üzeri
diyabetik nefropati varlığı, HbA1c seviyesinin > %7 olması, D vitamini seviyesinin <
10 ng/ml (25 nmol/L) olması, Tip 2 diyabet tanısı olması, yaşın ≥ 55 olması, diyabete
bağlı bir komplikasyon nedeniyle cerrahi geçirilmiş olması, diyabetle ilişkili ek bir
hastalığın varlığı ve erkek cinsiyet şeklinde sıralanabilir. Sonuç olarak diyabetik
hastalar değerlendirilirken saydığımız risk faktörlerine sahip olanların asemptomatik
olsalar dahi detaylı bir ürolojik değerlendirmeden geçirilmesi gerektiğini
önermekteyiz.
Diabetes mellitus, which had an increased prevalance and common complications, is a serious health problem all over the world. It has many unfavourable effects on lower urinary tract due to being a systemic disease. It causes a wide spectrum of obstructive and irritative lower urinary tract symptoms with several pathophysiological mechanisms. It is believed that the alterations of severity and frequency of these symptoms are related to diabetes and its chronic complications. The aim of our study is to investigate the relationship between physiopathological changes related to diabetes and lower urinary tract dysfunction. A total of 100 patient with the diagnosis of type 1 and type 2 diabetes who had been followed between the dates of January 2013 to January 2016 in Ege University Faculty of Medicine, Department of Endocrinology were involved in our study. All the data of the patients were evaluated retrospectively. All patients’ age, sex, type of diabetes, duration of diabetes, diabetes related comorbid disease, previous surgery related to diabetic complications, Body Mass Index (BMI), serum fasting glucose level, serum glycosylated hemoglobin level, Glomerular Filtration Rate (GFR), serum vitamin D level, presence of diabetic neuropathy, presence of diabetic retinopathy, average flow rate, post void residual volume (PVR), IPSS scores, ICIQ-SF scores and OAB-Q SF scores were recorded. There was 62 (%62) female and 38 (%38) male patient in the whole group. 27 (%27) of the patients had diagnosis of type 1 diabetes mellitus and 73 (%73) of the patients had diagnosis of type 2 diabetes mellitus. There was 59 (%59) patient with diagnosis of diabetic neuropathy and 38 (%38) patient with diagnosis of diabetic retinopathy. Mean age was 50.5±16.6, mean BMI was 28.5±8.3 kg/m², mean diabetes duration was 13.2±9.2 years, mean plasma fasting glucose level was 172.3±73.9 mg/dl, mean glycosylated hemoglobin was % 8.8±2.4, mean GFR was 110.5±43.2 ml/dk/1.73m² and mean serum vitamin D level was 25.4±26.4 nmol/L in the whole patient group. Statistical analysis was performed by comparing all recorded data of the patients with uroflowmetry measurement values, PVR volume, IPSS scores, ICIQ-SF scores and OAB-Q SF scores. As a result of the statistical analysis diabetic neuropathy was associated with lower average flow rates (p=0,0002), higher ICIQ-SF total scores (p=0,015), higher ICIQ-SF incontinence severity scores (p=0,031), higher ICIQ-SF quality of life scores (p=0,038), higher OAB-Q SF symptom severity scores (p=0,022) and lower OAB-Q SF quality of life scores (p=0,003). Moreover diabetic nephropathy was associated with higher ICIQ-SF total scores (p=0,02) and ICIQ-SF quality of life scores (p=0,011). Also statistical analysis showed a significant association between higher glycosylated hemoglobin levels and lower OAB-Q SF quality of life scores (p=0,026). Furthermore vitamin D deficiency was associated with higher PVR volumes (p=0,006). A statistical significant relationship was found between previous surgeries related to diabetic complications and lower average flow rates (p=0,01). Also previous surgeries were associated with voiding dysfunction in these patients (p=0,006). In addition to these findings type 2 diabetes mellitus was shown to be associated with lower average flow rates (p=0,003) and higher PVR volumes (p=0,047). Another significant finding was about male gender and lower OAB-Q SF quality of life scores (p=0,035). Finally higher OAB-Q SF symptom severity scores (p=0,007) and lower OAB-Q SF quality of life scores (p=0,002) were found in elderly patient group. To summarize, in this study the pathophysiological mechanisms and the relationship between diabetes mellitus and lower urinary tract dysfunction are evaluated with the guidance of the literature. The results obtained from our study showed that the presence of diabetic neuropathy, presence of diabetic nephropathy higher than stage 2, glycosylated hemoglobin levels higher than %7, presence of vitamin D deficiency, diagnosis of type 2 diabetes mellitus, age older than 55, previous surgery related to diabetic complications, presence of diabetes related comorbid diseases and male gender are more likely to develop any kind of lower urinary tract dysfunction than other diabetic patients. Finally we recommend that the evaluation of lower urinary tract should be done as a routine part of the evaluation of diabetic patients with emphasized risk factors even if they are asymptomatic.
Diabetes mellitus, which had an increased prevalance and common complications, is a serious health problem all over the world. It has many unfavourable effects on lower urinary tract due to being a systemic disease. It causes a wide spectrum of obstructive and irritative lower urinary tract symptoms with several pathophysiological mechanisms. It is believed that the alterations of severity and frequency of these symptoms are related to diabetes and its chronic complications. The aim of our study is to investigate the relationship between physiopathological changes related to diabetes and lower urinary tract dysfunction. A total of 100 patient with the diagnosis of type 1 and type 2 diabetes who had been followed between the dates of January 2013 to January 2016 in Ege University Faculty of Medicine, Department of Endocrinology were involved in our study. All the data of the patients were evaluated retrospectively. All patients’ age, sex, type of diabetes, duration of diabetes, diabetes related comorbid disease, previous surgery related to diabetic complications, Body Mass Index (BMI), serum fasting glucose level, serum glycosylated hemoglobin level, Glomerular Filtration Rate (GFR), serum vitamin D level, presence of diabetic neuropathy, presence of diabetic retinopathy, average flow rate, post void residual volume (PVR), IPSS scores, ICIQ-SF scores and OAB-Q SF scores were recorded. There was 62 (%62) female and 38 (%38) male patient in the whole group. 27 (%27) of the patients had diagnosis of type 1 diabetes mellitus and 73 (%73) of the patients had diagnosis of type 2 diabetes mellitus. There was 59 (%59) patient with diagnosis of diabetic neuropathy and 38 (%38) patient with diagnosis of diabetic retinopathy. Mean age was 50.5±16.6, mean BMI was 28.5±8.3 kg/m², mean diabetes duration was 13.2±9.2 years, mean plasma fasting glucose level was 172.3±73.9 mg/dl, mean glycosylated hemoglobin was % 8.8±2.4, mean GFR was 110.5±43.2 ml/dk/1.73m² and mean serum vitamin D level was 25.4±26.4 nmol/L in the whole patient group. Statistical analysis was performed by comparing all recorded data of the patients with uroflowmetry measurement values, PVR volume, IPSS scores, ICIQ-SF scores and OAB-Q SF scores. As a result of the statistical analysis diabetic neuropathy was associated with lower average flow rates (p=0,0002), higher ICIQ-SF total scores (p=0,015), higher ICIQ-SF incontinence severity scores (p=0,031), higher ICIQ-SF quality of life scores (p=0,038), higher OAB-Q SF symptom severity scores (p=0,022) and lower OAB-Q SF quality of life scores (p=0,003). Moreover diabetic nephropathy was associated with higher ICIQ-SF total scores (p=0,02) and ICIQ-SF quality of life scores (p=0,011). Also statistical analysis showed a significant association between higher glycosylated hemoglobin levels and lower OAB-Q SF quality of life scores (p=0,026). Furthermore vitamin D deficiency was associated with higher PVR volumes (p=0,006). A statistical significant relationship was found between previous surgeries related to diabetic complications and lower average flow rates (p=0,01). Also previous surgeries were associated with voiding dysfunction in these patients (p=0,006). In addition to these findings type 2 diabetes mellitus was shown to be associated with lower average flow rates (p=0,003) and higher PVR volumes (p=0,047). Another significant finding was about male gender and lower OAB-Q SF quality of life scores (p=0,035). Finally higher OAB-Q SF symptom severity scores (p=0,007) and lower OAB-Q SF quality of life scores (p=0,002) were found in elderly patient group. To summarize, in this study the pathophysiological mechanisms and the relationship between diabetes mellitus and lower urinary tract dysfunction are evaluated with the guidance of the literature. The results obtained from our study showed that the presence of diabetic neuropathy, presence of diabetic nephropathy higher than stage 2, glycosylated hemoglobin levels higher than %7, presence of vitamin D deficiency, diagnosis of type 2 diabetes mellitus, age older than 55, previous surgery related to diabetic complications, presence of diabetes related comorbid diseases and male gender are more likely to develop any kind of lower urinary tract dysfunction than other diabetic patients. Finally we recommend that the evaluation of lower urinary tract should be done as a routine part of the evaluation of diabetic patients with emphasized risk factors even if they are asymptomatic.
