Exploring Female Diabetic Patients' Incidence of Lower Urinary Tract Symptoms (LUTS), Factors Related to Luts, Correlation between Luts and Qol, and Effects of an Intervention on Diabetes Control, Lower Urinary Tract Health, QOL, and Knowledge About

Exploring female diabetic patients' incidence of lower urinary tract symptoms (LUTS), factors related to LUTS, correlation between LUTS and quality of life (QOL), and effects of an intervention on diabetes control, lower urinary tract health, QOL, and knowledge about LUTS Diabetes is a worldwide major health issue due to its increasing prevalence and devastating consequences. Poor diabetes control may lead to many chronic complications including macrovascular/microvascular diseases and neuropathy. Previous literature showed that diabetic neuropathy received less attention than diabetes-related macrovascular/microvascular diseases. Among varied system disturbances related to diabetic neuropathy, diabetes-related bladder dysfunctions/ LUTS are a category that is not well studied. Information related to the incidence, associated factors, management strategies, or effects of available management strategies for diabetes-related bladder dysfunctions/LUTS is limited. Understanding the incidence of and factors related to LUTS is helpful for identifying female diabetic patients at risk. Developing preventive strategies requires understanding multiple factors that affect LUTS reporting in patients from different backgrounds. Interventions related to modifiable factors such as behavioral interventions, exercise, and lifestyle changes have been reported as beneficial strategies to promote LUTS. However, current evidence shows that few studies had been conducted to explore the efficacy of common conservative treatments of LUTS on diabetes-related bladder dysfunctions/LUTS. The major aims of this study are to estimate the incidence of LUTS, to identify possible factors related to LUTS, to explore correlation between LUTS and QOL, and to examine the effects of an intervention on diabetes control, lower urinary tract health, QOL, and knowledge about LUTS in female type 2 diabetic patients. The results of this study will contribute to knowledge about diabetes-related LUTS, and lead to appropriate interventions or management strategies about diabetes-related LUTS. Two studies will be conducted at 2 metabolism/endocrinology outpatient departments in two hospitals. The first study will recruit 254 female type 2 diabetic patients. Incidence of LUTS, uroflowmetry data, possible factors related to LUTS, QOL, and correlation between LUTS and QOL will be explored. Three hundred and thirty female type 2 diabetic patients with at least one type of LUTS will be invited to the second study. Participants will be randomly assigned to intervention group 1, intervention group 2, or control group. For intervention group 1, the intervention will include a 4-hour education program and a 12-month exercise program (including pelvic floor muscle training). Based on the information presented on participants’ diet/fluid logs and voiding diary, individualized suggestions related to scheduled voiding regimen will be provided. For intervention group 2, the same intervention delivered to intervention group 1 plus a 6-month individual treatment of transcutaneous electrical stimulation will be provided. For the control group, a 12-month body stretching section will be provided. Effects of the intervention on participants’ diabetes control, lower urinary tract health, QOL, and knowledge about LUTS will be examined. Intervention outcomes will be collected at 5 time points. Descriptive statistics will be used to demonstrate the incidence of LUTS and uroflowmetry data along with the distributions of participants’ individual characteristics, personal habits, and QOL. Chi-Square tests will be used to compare the incidence rates of different LUTS for patients with different characteristics. Logistic regression will be used to identify possible factors related to different LUTS. QOL scores for patients with LUTS and without LUTS will be compared. Paired t-tests will be used to examine the effects of the interventions on diabetes control (fasting plasma glucose, A1C, triglycerides, total cholesterol, HDL-C, LDL-C), lower urinary tract health (uroflowmetry data), QOL, and knowledge about LUTS. These intervention outcomes will be assessed by repeated measures analysis with linear mixed modeling procedures at 5 time points. About the effects of interventions on lower urinary tract health, percentages of the presence of LUTS and participants’ self-reported improvement, and the presentations of voiding patterns on participants’ voiding diaries will be analyzed also.