Elsevier

Urology

Volume 79, Issue 1, January 2012, Pages 102-108
Urology

Health Outcomes Research
Diabetes Treatment and Progression of Benign Prostatic Hyperplasia in Community-dwelling Black and White Men

https://doi.org/10.1016/j.urology.2011.08.065Get rights and content

Objective

To conduct a study to determine whether diabetes treatment is associated with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and progression in black and white men. Diabetes has been associated with BPH and LUTS in aging men.

Methods

Using the Olmsted County Study of Urinary Symptoms and Health Status among Men and the Flint Men's Health Study, we examined how the use of medical therapy (eg, insulin regimens, oral hypoglycemics) related to changes in LUTS severity, maximal urinary flow rate measured by uroflowmetry, prostate volume determined by transrectal ultrasonography, and serum prostate-specific antigen concentrations.

Results

Of the 2226 men participating in the Olmsted County Study of Urinary Symptoms and Health Status among Men and the Flint Men's Health Study, 186 men reported a history of diabetes, 76.9% of whom were treated with medical therapy. Overall, the men with diabetes had significantly greater odds of moderate/severe LUTS (age- and race-adjusted odds ratio 1.37, 95% confidence interval 1.00-1.87) compared with those without diabetes. However, among the diabetic men, those not taking medication had greater odds of moderate/severe LUTS than those taking medication. This association among men not taking medication was seen for 5 of the 7 individual symptoms. The prostate volume and prostate-specific antigen level were not significantly associated with diabetes treatment. No significant differences were observed for the annual change in BPH characteristics by diabetes treatment status.

Conclusion

These findings suggest that the presence of diabetes and subsequent poor glycemic control might be less related to prostate growth and more to the dynamic components of lower urinary tract function. Additional evaluations of the associations between glycemic control and BPH progression are warranted.

Section snippets

Study Population

Details on subject selection for the OCS and FMHS have been previously published.3, 4 In brief, the OCS and FMHS are population-based, prospective cohort studies established to evaluate the natural history of BPH in white and black male residents of Olmsted County, Minnesota, and Genesee County, Michigan, respectively.

In the OCS, 2115 of 3874 eligible white men aged 40-79 years in 1990 without a history of prostate cancer or surgery or other conditions known to interfere with voiding, including

Results

Of the 2226 total participants (1863 white and 363 black men), 186 (8.4%) had a self-reported history of diabetes (Table 1). The mean age at baseline was 62.5 ± 10.4 years (standard deviation) and 57.5 ± 10.1 years in those with and without diabetes, respectively (P < .001). Overall, 78.8% of men were overweight/obese (body mass index ≥25 kg/m2), and men with diabetes were more likely to be overweight than were the men without diabetes (Table 1). Black men were also more likely to have a

Comment

Type 2 diabetes, which affects 90%-95% of people with diabetes, has been associated with bladder dysfunction, typically resulting in impairment of the detrusor.7, 8 Impaired detrusor function results in a lower maximal flow rate for any given level of bladder outlet resistance and can increase the postvoid residual urine volume and LUTS severity.7 BPH is also characterized by its presentation of LUTS, including a reduced maximal urinary flow rate and increased postvoid residual urine volume.

Conclusions

In the present community-based study of BPH and diabetes, we have demonstrated associations between diabetes treatment and increased LUTS, particularly irritative LUTS severity. Moreover, the magnitude of the association between irritative LUTS and diabetes was most pronounced in diabetic men who were not taking medication. Furthermore, no strong evidence was found for an association between diabetes and BPH across measures more specific to BPH (ie, prostate volume, PSA level). Taken together,

References (29)

Cited by (26)

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    These receptors are the target for pharmacotherapy. In addition to increasing age, risk factors for the development of BPH include African American race,10 obesity,11 type 2 diabetes mellitus,12 high levels of alcohol consumption,13 and physical inactivity.14 Men with symptomatic BPH may present with obstructive symptoms, irritative symptoms, or a combination of both (Table 1).

  • Metabolic syndrome and benign prostatic hyperplasia: An update

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    Since insulin resistance is shown to be an independent predictor of severe LUTS [110], reducing insulin resistance may serve as a means to prevent LUTS. Using the Olmsted County Study of Urinary Symptoms and Health Status among Men and the Flint Men's Health Study, Sarma et al. [111] looked into the use of oral hypoglycemics and its relationship with LUTS and BPH. The odds of moderate or severe LUTS was found significantly greater in men with diabetes (age- and race-adjusted OR = 1.37, 95%CI: 1.00–1.87) compared with men without diabetes.

  • Hyperglycemia, hyperinsulinemia, insulin resistance, and the risk of bph/luts severity and progression over time in community dwelling black men: The flint men's health study

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    At least 1 study that examined HbA1c levels and measures of BPH, observed a strong positive association.22 Additionally, in this cohort, we have previously observed significant elevated odds of LUTS in men with diabetes and specifically in diabetic men not taking medications for their condition suggesting that the condition and indications for its severity do in fact demonstrate increased risk for urinary symptoms.23 Although we observed in that study that diabetes was associated with increased LUTS, the lack of associations with prostate volume and serum PSA levels, measures more specific to prostate disease, suggest that the impact of diabetes on LUTS is likely attributed to glycosuria and increased urine volumes (diabetic neuropathy).

  • Benign prostatic hyperplasia and lower urinary tract symptoms

    2012, New England Journal of Medicine
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    In addition to levels of endogenous testosterone and dihydrotestosterone,9 other physiological markers associated with an increased risk of benign prostatic hyperplasia include high levels of dehydroepiandrosterone and estradiol,9 insulin-like growth factors,10 and inflammatory markers (e.g., C-reactive protein).11–13 Additional risk factors include black (vs. white) race,14 obesity,15 diabetes,16 high levels of alcohol consumption,17 and physical inactivity18; mechanisms underlying these associations remain poorly understood. Normal micturition requires that the bladder detrusor muscle relax between voidings and contract to overcome resistance of the bladder outlet (i.e., the prostate and bladder neck) during voiding.19,20

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Funding Support: This research was supported by the Urologic Diseases in America Project.

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