Previous studies have shown a high prevalence of and an increased risk to develop urinary incontinence and associated symptoms among women with Type 1 diabetes (T1D) [1, 2]. However, there seems to be a lack of studies of all the Lower Urinary Tract Symptoms (LUTS) and level of bother related to these symptoms. 
The aim of the study was to investigate the prevalence and level of bother of Lower Urinary Tract Symptoms and symptoms of depression among middle-aged women with long-lasting Type 1 Diabetes.

A cross-sectional study using a self-reporting questionnaire including validated instruments and background questions was chosen. Women aged 45-66 years with T1D for at least 15 years were identified from clinical electronic medical records at four endocrinological clinics. 
Diabetes status was self-reported by the year of diagnose. Questions about background such as social status, education, length, weight, smoking, and current medication complemented the formal instruments. BMI (body mass index) was calculated and categorized according to the established definition. LUTS was measured by ICIQ-LUTS. The instrument contains 12 questions within three domains: incontinence, voiding and filling. The percentage of bother of symptoms, on a scale 0-10 was used, where four or more was defined as having bother. In addition, number of episodes of urinary tract infections during the last year was included. The Patient Health Questionnaire (PHQ-9) consists of nine questions intended to estimate the severity of depressive symptoms with a maximum score was 27. A score of 10-27 indicate moderate to severe symptoms of depression [3]. 
Descriptive statistical analysis of background factors, self-reported occurrence of LUTS, level of bother and depression was used. Mean values, standard deviations and frequencies were calculated for nominal data, and median and range for categorical data.

Totally 212 women answered the questionnaire, mean age of 54.04 (SD: 5.83) years.
The women stated having T1D at mean 36.2 years (SD 11.4) and had BMI mean 26.54 (SD 5.83) although 23.4 % had BMI 30 and over, 13 % reported smoking daily or occasionally. In total 37.1% of the women had had gynaecological or urological surgery and 26 % at least one Caesarean section. 
The results showed a high prevalence of symptoms leakage as well as urgency. Nocturia two or more times per night was reported by 17.4%. Leakage problems were most bothersome together with urgency and nocturia (Table 1 and 2). Furthermore, 22.6 % of the women reported that they had urinary tract infection during the last year and of those, 45% had two or more episodes. In total, 39.8% reported mild to severe symptoms of depression.

Women having T1D for more than 15 years have a high prevalence of all urinary tract symptoms compared with other studies of the same age group. They were also bothered by all types of symptoms. Surprisingly, voiding symptoms as intermittent stream and hesitancy was reported by more than one third of the women. Confounding factors to consider are that 25% were obese, 37% had gone through gynecological or urological surgery and 13% were smokers.

Already in 2009, similar results were reported although for younger women. Yet more then10 years, the result of our study shows that T1D women still do not get the attention needed to reduce the wide range of urinary problems. In addition, the women are highly bothered of the symptoms and showed depressive symptoms. As these women are under a regular check up in the endocrinological care, a more multidisciplinary approach could help them as these symptoms influence their daily life and mental health to a high extent.

Sarma AV, Kanaya AM, Nyberg LM, Kusek JW, Vittinghoff E, Rutledge B, Cleary PA, Gatcomb P, Brown JS; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Urinary incontinence among women with type 1 diabetes--how common is it? J Urol. 2009 Mar;181(3):1224-30. doi: 10.1016/j.juro.2008.11.024.
Sarma AV, Kanaya A, Nyberg LM, Kusek JW, Vittinghoff E, Rutledge B, Cleary PA, Gatcomb P, Brown JS; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Risk factors for urinary incontinence among women with type 1 diabetes: findings from the epidemiology of diabetes interventions and complications study. Urology. 2009 Jun;73(6):1203-9. doi: 10.1016/j.urology.2008.11.009.
Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry. 2015 Jan-Feb;37(1):67-75. doi: 10.1016/j.genhosppsych.2014.09.009.