Lifestyle Intervention Is Associated With Lower Prevalence of Urinary Incontinence
The Diabetes Prevention Program
Jeanette S. Brown, MD, Rena Wing, PHD, Elizabeth Barrett-Connor, MD, Leroy M. Nyberg, MD, PHD, John W. Kusek, PHD, Trevor J. Orchard, MD, Yong Ma, MS, Eric Vittinghoff, PHD, MPH, Alka M. Kanaya, MD for the Diabetes Prevention Program Research Group
Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, Rockville, Maryland
Address correspondence and reprint requests to Jeanette S. Brown, MD, Diabetes Prevention Program Research Group, The Biostatistics Center, George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852. E-mail: firstname.lastname@example.org
OBJECTIVEDiabetes is associated with increased urinary incontinence risk. Weight loss improves incontinence, but exercise may worsen this condition. We examined whether an intensive lifestyle intervention or metformin therapy among overweight pre-diabetic women was associated with a lower prevalence of incontinence.
RESEARCH DESIGN AND METHODSWe analyzed data from the Diabetes Prevention Program, a randomized controlled trial in 27 U.S. centers. Of the 1,957 women included in this analysis, 660 (34%) were randomized to intensive lifestyle therapy, 636 (32%) to metformin, and 661 (34%) to placebo with standard lifestyle advice. The main outcome measure was incontinence symptoms by frequency and type by a validated questionnaire completed at the end-of-trial visit (mean 2.9 years).
RESULTSThe prevalence of total (stress or urge) weekly incontinence was lower among women in the intensive lifestyle group (38.3%) than those randomized to metformin (48.1%) or placebo (45.7%). This difference was most apparent among women with stress incontinence (31.3% for intensive lifestyle group vs. 39.7% for metformin vs. 36.7% for placebo, P = 0.006). Changes in weight accounted for most of the protective effect of the intensive lifestyle intervention on stress incontinence.
CONCLUSIONSLess-frequent urinary incontinence may be a powerful motivator for women to choose lifestyle modification to prevent diabetes.