People living with type-2 diabetes are at increased risk of various infections, with urinary tract infections being quite common. Urinary tract infections are also more severe and carry worse outcomes in people with type-2 diabetes.

A study conducted in 2014 found that people with diabetes are two-times more likely to develop UTI versus people without diabetes.[1]

The spectrum of UTI also ranges from asymptomatic bacteriuria (ASB) to lower UTI (bladder infection or cystitis), inflammation of the kidney (pyelonephritis), and severe urinary infection. [2]^,[3] Serious complications of UTI are all encountered more frequently in type 2 diabetes than in the general population. Urinary tract infections are more common in women than men.

Why are people with diabetes more prone to urinary tract infections?

Generally, UTIs begin when pathogens that reside in the gastrointestinal tract are able to colonize the urethra. From urethra, they migrate to the bladder and invade and colonize the upper urinary tract.

It is useful to distinguish between upper (kidney) and lower (bladder, prostate and urethra) urinary tract infections as upper urinary tract infections generally tend to be more severe.

People with diabetes are more prone to UTI due to the following underlying reasons:

• Impairments in the immune system
• Poor glucose control
• Incomplete bladder emptying due to autonomic neuropathy (condition that result when nerves that carry messages to and from the brain and spinal cord are damaged or diseased)
• Use of certain drugs that increase the concentration of glucose in urine

Certain other conditions also predispose one to develop UTIs like – kidney stones, an enlarged prostate gland, menopause, pregnancy, females using a diaphragm for birth control, use of urinary catheter for long time, having surgery on the urinary tract system etc.

What are the symptoms of urinary tract infection in people with diabetes?

Symptoms of urinary tract infection are like patients without diabetes, though some people with neuropathy may have altered clinical signs due to the damage to the peripheral nerves.

It must be noted that in people with asymptomatic bacteriuria, there might be complete absence of any symptom.

The common symptoms of urinary tract infection include:

• fever
• strong and frequent urge to urinate
• cloudy, bloody, or strong-smelling urine
• pain or a burning sensation when urinating
• nausea and vomiting
• muscle aches and abdominal pains

How to diagnose a urinary tract infection?

Screening of UTI must be carried out in people with diabetes at least once a year[4]. Your healthcare practitioner can prescribe the below tests to diagnose a UTI:

• Urine analysis and culture
• Abdomen ultrasound
• X-ray
• Evaluation of bladder function

Treatment of a urinary tract infection

Treatment depends on several factors, including: presence and severity of symptoms, if infection is localized in the bladder or also involves the kidney, presence of urologic abnormalities, accompanying renal function alterations.

The treatment of UTI for diabetic patients requires a longer period, lasting from seven to fourteen days, of oral antibiotic treatment but some serious kidney infections may require hospitalization, including a course of intravenous antibiotics. Healthcare practitioners should always tailor antibiotic treatment according to the results of urine culture.

In patients requiring catheterization due to incomplete bladder emptying, intermittent catheterization should be preferred over a chronic indwelling catheter[5].

Prevention and Control

• Keep blood sugar level within normal range
• Drink plenty of water everyday
• Do not drink fluids that irritate the bladder, such as alcohol
• Genital area must be kept clean.
• Urinate when you feel the need; don’t resist the urge to urinate
• Going to the toilet after sex
• Regularly washing your genitals
• Wiping your bum from front to back

Conclusion:

People with diabetes have a higher incidence of UTI than their nondiabetic counterparts with a higher severity UTI which can be a cause of complications. Therefore, good glycaemic control in people with diabetes may help in controlling the infections. Accurate screening for UTI in diabetic patients is also critical to enable the appropriate treatment, avoiding related complications.

(Dr Syed Iftikhar Ali is a doctor by profession. He completed his MBBS from King George Medical University, Lucknow and his MS in general surgery from Jhansi Medical College in 2013. He has more than 7 years of work experience in the field of medicine.)

[1]  Fu AZ, Iglay K, Qiu Y, Engel S, Shankar R, Brodovicz K. Risk characterization for urinary tract infections in subjects with newly diagnosed type 2 diabetes. J Diabetes Complications. 2014;28(6):805–810

[2] Mnif MF, Kamoun M, Kacem FH, et al. Complicated urinary tract infections associated with diabetes mellitus: pathogenesis, diagnosis and management. Indian J Endocrinol Metab. 2013;17(3):442–445

[3] Kofteridis DP, Papadimitraki E, Mantadakis E, et al. Effect of diabetes mellitus on the clinical and microbiological features of hospitalized elderly patients with acute pyelonephritis. J Am Geriatr Soc. 2009;57(11):2125–2128

[4] Guillausseau PJ, Farah R, Laloi-Michelin M, Tielmans A, Rymer R, Warnet A. Infections urinaires et diabète sucré [Urinary tract infections and diabetes mellitus]. Rev Prat. 2003;53(16):1790‐1796.

[5]  Hooton TM, Bradley SF, Cardenas DD, et al. Infectious Diseases Society of America Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625–663