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Cited by 2Urinary Bladder and Prostate ResearchDiabetes Treatment and ManagementPelvic floor disorders treatments

Urinary incontinence in US adults aged ≥55 years with type 2 diabetes and indications for SGLT2is: NHANES 2013–2020

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Lee, Alexandra K, Lipska, Kasia J, Callahan, Kathryn E, Raphael, Eva, Lee, Sei J·2025·BMJ Open Diabetes Research & Care
DOI 10.1136/bmjdrc-2025-004929PMC PMC12314932
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Abstract

Objective: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended as first-line cardiorenal protective therapy in type 2 diabetes. Because SGLT2is cause glycosuria and increase urine volume, they may exacerbate incontinence symptoms among patients with pre-existing urinary incontinence. Our objective was to determine how many adults meeting guideline indications for SGLT2i have frequent urinary incontinence. Research design and methods: We conducted a cross-sectional analysis of National Health And Nutrition Examination Survey (NHANES) participants aged ≥55 with type 2 diabetes in 2013–2020. We determined whether participants met American Diabetes Association guideline indications for an SGLT2i due to heart failure or chronic kidney disease, or due to atherosclerotic cardiovascular disease or high cardiovascular risk (for the latter two cardiovascular indications, GLP-1RAs are guideline-recommended alternative medications). Frequent urinary incontinence was defined by self-report of leaking urine daily/nightly or a few times per week. Results: There were 1726 NHANES participants aged ≥55 with type 2 diabetes, representing 16.0 million US adults; 19.6% (95% CI 17.3% to 22.2%) (3.1 million) met indications for an SGLT2i specifically and 50.9% (95% CI 47.2% to 54.7%) (8.2 million) met indications for either an SGLT2i or a GLP-1RA. Among those with indications for an SGLT2i specifically, 32.4% (95% CI 25.9% to 39.8%) had frequent urinary incontinence, representing 333 000 men and 685 000 women. Among those with indications for either an SGLT2i or GLP-1RA, 25.5% (95% CI 20.8% to 30.8%) had frequent urinary incontinence, representing 630 000 men and 1413 000 women. Conclusions: Frequent urinary incontinence affects >15% of men and >40% of women aged ≥55 years with guideline indications for SGLT2i. Studies are needed to determine if incontinence increases risk of genital infections when initiating SGLT2is.

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Cited by

Sorted by citations

Authors
Lee, A. K., Lipska, K. J., Callahan, K. E., Raphael, E., & Lee, S. J.
Affiliations
  • University of California, San Francisco (US)
  • Yale University (US)
  • Wake Forest University (US)
  • San Francisco VA Medical Center (US)
Corresponding author
Lee, Alexandra K
ORCID
Venue
BMJ Open Diabetes Research & Care
Publisher
BMJ
Published
2025-07-31
Volume
13
Issue
4
Pages
e004929
ISSN
2052-4897 (ISSN-L)
DOI
10.1136/bmjdrc-2025-004929
PMC
PMC12314932
OpenAlex
W4412843179
Cited by
2
References
4
Citations by year
2026: 1 · 2025: 1
FWCI
2.07
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institute on Aging (K01AG073532, K24AG066998, K76AG059986)
  • National Institute of Allergy and Infectious Diseases (K23AI166030)
Topics
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
Keywords
urinary incontinence, type 2 diabetes, SGLT2 inhibitors, GLP-1 receptor agonists, older adults, glycosuria, heart failure, chronic kidney disease, atherosclerotic cardiovascular disease, cardiorenal protection, sex differences, NHANES, drug safety, adverse drug reactions, diabetes management guidelines, women's health
MeSH terms
Sodium-Glucose Transporter 2 Inhibitors, Aged, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Nutrition Surveys, Prognosis, Risk Factors, United States, Urinary Incontinence

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