Demographic characteristics of Diabetes RRISK are summarized in . The group with diabetes had 486 women, while the group without diabetes included 1784 women. Women with diabetes compared to women without diabetes were slightly older (mean 56 vs. 55 years, p<0.01), more were Latina (22% vs. 17%, p=0.03), obese (BMI>30: 67% vs. 31%, p<0.001), and had poorer general health (self reported fair/poor health 22.5% vs. 5.7%, p<0.001). Among women with diabetes in the study, the mean (±SD) years with diabetes were 10 (±8.8) years. Nearly 95% were being treated with either oral medication (62%) or insulin (33%). The women self-reported complications of diabetes including peripheral neuropathy, retinopathy, and nephropathy ().
Characteristics of Diabetes Reproductive Risk factors for Incontinence Study at Kaiser (RRISK) Cohort (N =2270)
Characteristics of Diabetics in Diabetics RRISK
Over half of the women with diabetes had monthly or greater incontinence and over one third reported weekly or greater incontinence, significantly more than women without Diabetes RRISK diabetes (Monthly or greater: 50.9% vs 40.3% p<0.001, Weekly or greater: 35.4% vs 24.7% p<0.001, respectively) (). Among women with any incontinence, women with diabetes were more likely to report severe incontinence than women with diabetes (25.7% vs. 16.7% p<0.001, respectively). Among women with weekly incontinence, over a quarter of women with diabetes reported significantly greater bother with nocturnal incontinence compared to women without diabetes (Quite a bit or extreme bother: 17.5% vs. 10.5%, p=0.02).
Urinary Incontinence Characteristics of the Diabetes RRISK Cohort (N = 2270)
After adjusting for common risk factors, the odds ratio of incontinence for diabetics vs. non-diabetics was 1.18 [95% CI [0.92–1.50]. Several race differences in the multivariable analysis were significant, even with adjustment for diabetes status. Whites were more likely than African Americans and Asians to be incontinent (2.15 [1.62–2.86] and 1.58 [1.17–2.14] respectively). Latinas were more likely than African Americans and Asians to be incontinent (2.17 [1.56–3.01] and 1.59 [1.12–2.26], respectively).
depicts help-seeking behaviors among women with weekly or greater incontinence by diabetes status. Women with diabetes were more likely to report that incontinence was a rare condition (17% vs. 6%, p<0.001) and that treatment does not fix the problem (15% vs. 8 %, p=0.01). There were some commonly held beliefs among women with and without diabetes. Nearly three quarters of women believed incontinence was a normal part of aging as well as nearly half thought it was normal after childbirth. About 10% of women felt there was no treatment for incontinence, treatment is risky/or harmful, or treatment doesn’t fix the problem.
Beliefs and Help Seeking Behavior Among Diabetes RRISK Women with Weekly or Greater Incontinence (N= 602)
Over 30% of women with diabetes never discussed their incontinence with others, significantly greater than women without diabetes (30.7% vs. 21.7% p=0.02, respectively). Women with diabetes were also less likely to discuss their incontinence with their spouse/partner (29% vs. 38% p=0.03). Less than 50% of women with diabetes discussed their incontinence with a doctor (37.4% vs. 52.5% p<0.001). Women had incontinence about 3–4 years prior to discussing the condition with a doctor ().
Reasons why women did or did not seek care by diabetes status are summarized in . Women with diabetes when compared to women without diabetes differed significantly in some reasons they sought care. Women with diabetes sought care because incontinence made them feel older (36% vs 16% p=0.01), they were concerned there was a more serious disease (33% vs 13% p=0.01), and they were depressed about their incontinence (31% vs. 13% p=0.01). Over half of women with and without diabetes similarly sought treatment because their incontinence worsened (52% to 56%) or their incontinence was embarrassing (47 to 55%). Many women also sought treatment because of an odor of urine (35% to 44%). Most reasons for not seeking treatment did not differ by diabetes status and most commonly were that it was considered a normal part of aging, women tended to put up with incontinence, they did not know what types of help were available, and felt they could manage the leakage on their own.
Among Diabetes RRISK Women with Weekly Incontinence: Reasons Women Did or Did Not Seek Treatment