糖尿病婦女的尿失禁通常會被忽略
作者：Jill Stein
出處：WebMD醫學新聞
June 3, 2010 (加州舊金山) — 一個研究小組在美國泌尿科協會(AUA)2010年科學會議中表示，醫師需密切注意女性糖尿病患發生尿失禁(UI)的可能性，因為這類病患有35%發生每週至少一次的失禁。
研究者表示，根據他們的研究發現，每週都有UI的糖尿病女性，尋求治療者少於那些無糖尿病的UI女性，對於UI和許多UI相關憂鬱症的暸解也較少。
舊金山Kaiser Permanente泌尿婦科主任Michelle Y. Morrill醫師在訪問中向Medscape Urology解釋，因為有UI 的糖尿病女性通常不會告訴醫師她們的症狀、處理她們因UI導致憂鬱的事實，我們相信，醫師照護糖尿病婦女時，為她們進行例行性UI篩檢是相當重要的。
好消息是，現在有UI的有效治療方式，壞消息是，糖尿病婦女通常未能接受這些治療，就只是因為我們不知道她們有UI。
Morrill醫師表示，問卷或許不是篩檢UI的最佳方式，她解釋，對於試著用來在檢查時表達病患的一般健康狀況時，篩檢型問卷可能稍嫌麻煩。
我的建議是告訴病患「許多婦女有急尿或漏尿症狀，對於有這些症狀的婦女，有許多治療方式，包括運動或藥物與手術，您有興趣瞭解更多有關這些治療的資訊嗎？」
【大型人口基礎的研究顯示糖尿病婦女的UI盛行率高】
研究者比較488名有UI的糖尿病婦女以及1784名有UI但無糖尿病的婦女，探討她們對UI的知識、相信程度與尋求治療等方面的差異，研究對象的平均年紀為55± 9歲。
Morrill醫師觀察發現，尿失禁與糖尿病是常見且花費大的異常，且糖尿病是UI的已知風險因素。
她表示，遺憾的是，許多婦女並未尋求照護，即便狀況已經嚴重影響到她們的生活品質時。
迄今少有檢視糖尿病婦女暸解UI並尋求照護的研究。
該試驗的研究對象來自「Reproductive Risks for Incontinence Study」這項研究，這個進行中的研究包括了一個大範圍、人口為基礎、含各種族的隨機挑選女性世代，這些人都是北加州「Kaiser Permanente Medical Care Program」這項計畫的會員，這是一個整合型健康照護傳遞系統之計畫，有超過300萬名會員。
UI之出現是由自我報告的漏尿頻率確認，使用Sandvik嚴重度量表(Sandvik Severity Scale)測量UI的嚴重度，該量表被廣為認可用來評估女性UI的嚴重度。
分析聚焦在每週至少發生1次UI的婦女，因為每週發生UI已經顯示是病患是否尋求照護的一個重要確認因素。
【UI 對於糖尿病婦女產生的問題大於非糖尿病婦女】
Kaiser Permanente研究有3個主要發現：非糖尿病婦女的每週UI盛行率為25%，糖尿病婦女為35%(P< .001)；糖尿病婦女比非糖尿病婦女更不會和配偶或醫師護士討論她們的UI；在有尋求治療的UI婦女中，糖尿病患者比較關心她們的嚴重病情(33% vs 13%；P= .007)、對於她們的UI比較憂鬱(31% vs 13%；P= .01)、比較可能表示這讓她們覺得自己比較衰老(36% vs 16%；P= .01)。
Morrill醫師強調，需要更多研究來確認糖尿病婦女之UI發生率增加的機轉，以確認預防和治療UI的策略。她表示，我們的目標是減少這個影響許多糖尿病婦女之慢性異常的醫療、心理社會和經濟上的負擔。
阿拉巴馬大學醫學助理教授Alayne Markland醫師向Medscape Urology表示，本研究幫助確認UI的一個高風險族群，告訴我們的是，我們需要針對這群病患進行更嚴謹的UI篩檢與治療。因為該研究顯示糖尿病婦女比較不會尋求UI症狀之照護，身為醫師的我們必須更主動積極詢問病患有關UI與其他下泌尿道的症狀，目標是改善她們的整體生活品質。
National Institutes of Health以及Kaiser Permanente Division of Research資助該研究。Morrill醫師與Markland醫師皆宣告沒有相關財務關係。
美國泌尿科協會(AUA)2010年科學會議：摘要1667。發表於2010年6月1日。
Urinary Incontinence in Diabetic Women Is Often Neglected
By Jill Stein
Medscape Medical News
June 3, 2010 (San Francisco, California) — Physicians need to pay closer attention to the possibility of urinary incontinence (UI) in their female diabetic patients, because 35% of this population reports at least weekly episodes, a group said here at the American Urological Association 2010 Annual Scientific Meeting.
The researchers issued their recommendation after their study found that diabetic women with weekly UI episodes seek treatment less often than nondiabetic women with UI and have less understanding of UI and more UI-related depression.
"Given that diabetic women with IU may not report their symptoms to their physician, coupled with the fact that their UI may lead to depression, we believe that it is extremely important that physicians who care for women with diabetes routinely screen them for UI," Michelle Y. Morrill, MD, director of urogynecology for Kaiser Permanente in San Francisco, California, explained to Medscape Urology during an interview.
"The good news is that effective treatments are available for UI. It's unfortunate that diabetic women are often denied such treatments simply because we don't know they suffer from UI."
Dr. Morrill said that questionnaires are probably not the best way to screen for UI. "Screening questionnaires can be cumbersome when trying to address all general health issues for patients at a check-up," she explained. "My recommendation is to say to a patient: 'Many women experience urinary urgency or leakage. For women who are bothered by these symptoms, there are a variety of treatments, ranging from exercises to medications and surgery. Are you interested in learning more about these treatments?'?"
Large Population-Based Study Shows High Prevalence of UI in Diabetic Women
The investigators compared treatment-seeking for, knowledge of, and beliefs about UI in 488 diabetic women with UI and in 1784 nondiabetic women with UI. The mean age of the study population was 55?± 9 years.
"Urinary incontinence and diabetes mellitus are common and costly disorders, and diabetes is a known risk factor for UI," Dr. Morrill observed.
Regrettably, many women do not seek care even though the condition significantly affects their quality of life, she said.
Few studies to date have examined patterns of UI care-seeking and understanding in diabetic women.
Participants in the trial were drawn from the Reproductive Risks for Incontinence Study. The ongoing study consists of a large-scale, population-based, ethnically diverse cohort of randomly selected women who are members of the Kaiser Permanente Medical Care Program of Northern California, an integrated healthcare delivery system with more than 3?million members.
The presence of UI was determined by the frequency of self-reported urinary leakage, and UI severity was determined using the Sandvik Severity Scale. The scale has been widely validated for assessing the severity of female UI.
The analysis focused on women who had a UI episode at least once a week, because weekly UI has been shown to be an important determinant of whether or not patients seek care.
UI More Problematic in Diabetic Than in Nondiabetic Women
There were 3 key findings from the Kaiser Permanente study: the prevalence of weekly UI was 25% in nondiabetic and 35% in diabetic women (P?< .001); diabetic women were less likely than nondiabetic women to discuss their UI with their spouse/partner or with a doctor or nurse; and among women with UI who sought treatment, diabetics were more concerned that they had more serious disease (33% vs 13%; P?= .007), more depressed about their UI (31% vs 13%; P?= .01), and more likely to report that it made them feel older (36% vs 16%; P?= .01).
Dr. Morrill emphasized that more studies are needed to determine the mechanisms for the increased incidence of UI in diabetic women and to identify UI prevention and treatment strategies. "Our goal is to reduce the medical, psychosocial, and economic costs of this chronic disorder that affects many women with diabetes," she said.
"This study helps identify a high-risk group for UI, which tells us that we need to target this population for more rigorous UI screening and treatment, if indicated," Alayne Markland, DO, assistant professor of medicine at the University of Alabama at Birmingham, told Medscape Urology. "Since the study showed that diabetic women are less likely to seek care for UI symptoms, we as physicians need to be more proactive in asking patients about UI and other lower urinary tract symptoms, with a goal of improving their overall quality of life."
The study was funded by the National Institutes of Health and the Kaiser Permanente Division of Research. Dr. Morrill and Dr. Markland have disclosed no relevant financial relationships.
American Urological Association (AUA) 2010 Annual Scientific Meeting: Abstract?1667. Presented June?1, 2010.
