Health Outcomes ResearchDiabetes Treatment and Progression of Benign Prostatic Hyperplasia in Community-dwelling Black and White Men
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)
- et al.
Urologic diseases in America project: benign prostatic hyperplasia
J Urol
(2008) - et al.
The prevalence of prostatism: a population-based survey of urinary symptoms
J Urol
(1993) - et al.
The natural history of lower urinary tract symptoms in black American men: relationships with aging, prostate size, flow rate and bothersomeness
J Urol
(2001) - et al.
The American Urological Association symptom index for benign prostatic hyperplasia: the Measurement Committee of the American Urological Association
J Urol
(1992) - et al.
Treatment for benign prostatic hyperplasia among community dwelling men: the Olmsted County study of urinary symptoms and health status
J Urol
(1999) - et al.
Effect of diabetes on lower urinary tract symptoms in patients with benign prostatic hyperplasia
J Urol
(2000) - et al.
Urinary incontinence in older women: who is at risk?Study of Osteoporotic Fractures Research Group
Obstet Gynecol
(1996) - et al.
Risk factors for clinical benign prostatic hyperplasia in a community-based population of healthy aging men
J Clin Epidemiol
(2001) - et al.
Association of lower urinary tract symptoms and the metabolic syndrome: results from the Boston Area Community Health Survey
J Urol
(2009) - et al.
Diabetes and benign prostatic hyperplasia progression in Olmsted County, Minnesota
Urology
(2006)
Limitations of using outcomes in the placebo arm of a clinical trial of benign prostatic hyperplasia to quantify those in the community
Mayo Clin Proc
Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms
J Urol
Urodynamic evaluation in simultaneous insulin-dependent diabetes mellitus and end stage renal disease
J Urol
Insulin-like growth factor-1, insulin-like growth factor binding protein-3, and body mass index: clinical correlates of prostate volume among black men
Urology
Cited by (26)
Effects of exercise on benign prostatic hyperplasia, lower urinary tract symptoms, and erectile dysfunction
2021, Molecular Mechanisms of Nutritional Interventions and Supplements for the Management of Sexual Dysfunction and Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
2019, Primary Care - Clinics in Office PracticeCitation Excerpt :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
2017, Asian Journal of UrologyCitation Excerpt :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
2013, UrologyCitation Excerpt :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 MedicineCitation Excerpt :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
Funding Support: This research was supported by the Urologic Diseases in America Project.