Epidemiological Insights into Lower Urinary Tract Symptoms among Adults with and without Diabetes in South India

Epidemiological Insights into Lower Urinary Tract Symptoms among Adults with and without Diabetes in South India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiological Insights into Lower Urinary Tract Symptoms among Adults with and without Diabetes in South India Sai shashank Gudla, Dhanaraju Magharla Dasaratha, Himasree Pithani, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7767844/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Lower urinary tract symptoms (LUTS) are highly prevalent and impact quality of life through sleep disruption, reduced productivity, and psychological distress. Type 2 diabetes mellitus (T2DM) has been implicated in exacerbating LUTS through mechanisms such as autonomic neuropathy and poor glycemic control. However, data from gender-inclusive, hospital-based cohorts in India are limited. Methods: This hospital-based, cross-sectional pilot study was conducted at a tertiary care urology center in Andhra Pradesh, India. Eighty adults with at least one LUTS were enrolled, including 40 with T2DM and 40 non-diabetic controls. Symptom burden was assessed using the International Prostate Symptom Score (IPSS), Urogenital Distress Inventory (UDI-6), and International Consultation on Incontinence Questionnaire (ICIQ-UI SF). Fasting blood glucose (FBG) levels were recorded, and management strategies documented. Statistical analyses included independent t-tests, chi-square tests, and multivariable regression. Results: Severe LUTS (IPSS ≥20) was more common in diabetics (35% vs. 20%), alongside higher frequencies of nocturia (30% vs. 25%) and urinary incontinence (25% vs. 20%). Although group differences were not statistically significant, FBG correlated positively with IPSS and UDI-6 scores, suggesting a link between glycemic status and symptom severity. Multivariable regression identified age as the strongest independent predictor of LUTS severity (p=0.008). α-blockers were the most frequently prescribed treatment in both groups. The prevalence of severe LUTS (IPSS ≥20) was higher in diabetics (35%) compared to non-diabetics (20%). Nocturia (≥2/night) was reported by 30% of diabetics and 25% of controls, while urinary incontinence was observed in 25% and 20%. Conclusion: This pilot study suggests that age is the predominant determinant of LUTS burden, while diabetes contributes indirectly through glycemic control. Larger multicentric studies are warranted to clarify metabolic and sex-specific influences, supporting integrated screening of LUTS in both geriatric and diabetic care pathways. Lower urinary tract symptoms Type 2 diabetes mellitus Prevalence Glycemic control Public health Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Lower urinary tract symptoms (LUTS) are a collection of urinary complaints arising from dysfunction of the bladder, urethra, or associated structures. They are broadly classified into storage symptoms (urgency, frequency, nocturia, incontinence), voiding symptoms (hesitancy, weak stream, straining, intermittency), and post-micturition symptoms (sensation of incomplete emptying, dribbling) [ 1 ]. LUTS are not disease-specific but represent a syndrome that significantly impairs quality of life and often coexist with systemic conditions such as diabetes mellitus. Studies estimate that nearly half of individuals over 40 years report at least one LUTS, with prevalence and severity increasing with age and comorbid conditions [ 2 ]. Beyond their high frequency, LUTS significantly impair quality of life, reducing sleep quality, workplace productivity, and mental health, while contributing to increased healthcare utilization and costs. In men, LUTS are frequently misattributed to benign prostatic hyperplasia (BPH), while in women they are often overlooked or dismissed as gynecological in origin, leading to underdiagnosis and undertreatment [ 3 ]. Type 2 diabetes mellitus (T2DM) has emerged as a critical determinant of LUTS, with global diabetes prevalence estimated at 537 million adults, projected to rise to 783 million by 2045. Diabetic bladder dysfunction, or “diabetic cystopathy,” is characterized by a spectrum ranging from overactive bladder to impaired bladder sensation and underactive detrusor function. Pathophysiological mechanisms include autonomic neuropathy, microvascular compromise, and metabolic dysregulation, which collectively disrupt bladder contractility, sensation, and urethral sphincter control [ 4 ]. Epidemiological data consistently demonstrate that individuals with diabetes have a higher prevalence of LUTS compared with non-diabetics. For instance, a recent NHANES-based analysis reported that diabetics had 77% greater odds of overactive bladder symptoms, with a dose–response association observed between glycemic markers such as HbA1c and fasting glucose and the risk of LUTS [ 5 ]. Despite these associations, existing literature has notable limitations. Many studies focus exclusively on diabetic populations or male cohorts with BPH, while few adopt a gender-inclusive approach. Yet, gender differences appear clinically relevant: Athanasopoulos et al. found that elevated HbA1c independently predicted moderate-to-severe LUTS in women, but this association was not evident in men. Similarly, retrospective analyses have shown that diabetic women exhibit distinct urodynamic features, including detrusor overactivity, larger bladder capacities, and impaired sensation, compared to their non-diabetic counterparts. These findings suggest sex-specific variations in diabetes-related LUTS, which remain underexplored [ 6 ]. Another critical factor is the role of glycemic control. Studies highlight that poor glycemic status is associated with increased LUTS severity, nocturia, and impaired bladder emptying. Longer duration of diabetes and HbA1c ≥ 7.5% have been linked to delayed bladder sensation, reduced detrusor pressure, and higher post-void residual volumes [ 7 ]. Furthermore, systemic inflammation may partly mediate the relationship between hyperglycemia and LUTS, as shown in population-based analyses. These findings underscore the importance of examining glycemic control as both a risk factor and a potential therapeutic target in diabetic bladder dysfunction [ 8 ]. Management of LUTS in diabetic populations presents additional challenges. While standard pharmacological therapies such as alpha-blockers, antimuscarinics, and beta-3 agonists are well established, evidence suggests that diabetics often require higher drug dosages and exhibit slower, less robust therapeutic responses [ 9 ]. Comorbidities such as hypertension further influence treatment outcomes, as patients with both diabetes and hypertension demonstrate more severe baseline symptoms and poorer responses to therapy. However, comparative data on management strategies in diabetic versus non-diabetic populations remain scarce, particularly in real-world tertiary care contexts [ 10 ]. Evidence from India and other low- and middle-income countries is especially limited, despite the high prevalence of both diabetes and LUTS in these settings. Singh et al. reported that LUTS prevalence was significantly higher among elderly diabetic men (64.6%) compared to non-diabetics (42.2%), with nocturia being the most common symptom. Importantly, LUTS severity correlated strongly with both diabetes duration and HbA1c levels, reinforcing the need for region-specific, clinically relevant studies [ 11 ]. From the identified research gaps, the present pilot study aims to provide a comprehensive, gender-inclusive comparison of LUTS in diabetic and non-diabetic adults attending a tertiary care hospital. Specifically, it will evaluate symptom prevalence and severity using validated scoring tools, assess the relationship between glycemic parameters (fasting blood glucose) and LUTS severity, and compare patterns of pharmacological management across groups. We hypothesize that diabetic adults will exhibit higher prevalence and greater severity of LUTS than non-diabetics, with poor glycemic control correlating with worse symptom burden. As a pilot investigation, this study will generate preliminary, context-specific insights that can guide larger, multicentric research, support the development of personalized management strategies, and contribute to global health priorities, including Sustainable Development Goal 3 (Good Health and Well-being) and Sustainable Development Goal 5 (Gender Equality). Methods Study Design This research was conducted as a hospital-based, observational, cross-sectional pilot study. The pilot design was selected to generate preliminary evidence, assess feasibility, and refine methodology for larger future studies. Study Setting and Duration The study was carried out in the Department of Urology, Goutham Urology & Kidney Centre, Rajamahendravaram, Andhra Pradesh, India, which is Top 1 urology care hospital in the city provides service for urban and semi-urban and rural populations. Data collection was conducted over a six-week period (July – August 2025). Study Population and Eligibility Adult patients aged above 18 years presenting with at least one LUTS persisting for ≥ 1 month were recruited consecutively from both outpatient and inpatient services. Inclusion criteria: Adults age of above 18. Presence of one or more LUTS (e.g., frequency, urgency, nocturia, weak stream, hesitancy, or incontinence). Confirmed diagnosis of Type 2 diabetes mellitus according to American Diabetes Association (ADA) criteria, or confirmed non-diabetic status by fasting blood glucose within normal limits. Willingness to provide informed consent. Exclusion criteria: Known cases of urological malignancy, neurogenic bladder, or spinal cord injury. History of urological surgery in the preceding six months. Pregnant women. Patients receiving medications that can induce urinary symptoms (e.g., diuretics). Presence of acute urinary tract infection at the time of assessment. These criteria ensured that observed LUTS were attributable to lower urinary tract dysfunction rather than confounding conditions. Tools and Measures Data were collected using a structured case record form. Demographic and clinical details, including age, sex, BMI, lifestyle factors, duration of diabetes, and comorbidities such as hypertension or chronic kidney disease, were documented. Symptom assessment employed validated questionnaires: International Prostate Symptom Score (IPSS): for evaluating severity of LUTS in males [ 12 ]. Urogenital Distress Inventory (UDI-6): Used to assess urinary distress in female participants [ 13 ]. International Consultation on Incontinence Questionnaire: Urinary Incontinence Quality of Life (ICIQ-IU QoL) short form: to measure the impact of LUTS on daily life and well-being in males and females [ 14 ]. Laboratory investigations included fasting blood glucose measured by enzymatic methods and Uroflowmetry to indicates the participants, further confirmed by symptom severity assessment. Treatment details regarding LUTS medications (e.g., alpha-blockers, antimuscarinics, beta-3 agonists, PDE5 inhibitors) and diabetes management (oral hypoglycemics, insulin) were recorded from patient medical records. Study Procedure Eligible participants were identified during outpatient visits or inpatient admissions. After consent, patients were classified as diabetic or non-diabetic based on history and fasting blood glucose values. Structured interviews were conducted in English or Telugu by trained investigators to minimize reporting bias. Clinical data, laboratory results, and treatment histories were corroborated using hospital records to enhance accuracy. The complete study procedure shown in the Fig. 1 . Data Analysis All collected data were entered and verified in Microsoft Excel. Continuous variables were presented as mean ± standard deviation (SD), while categorical variables were expressed as counts and percentages. Comparisons between diabetic and non-diabetic groups were performed using the independent samples t -test for continuous variables and the Chi-square test for categorical variables. A p-value of < 0.05 was considered statistically significant. Results Demographic and Clinical Characteristics A total of 80 participants were recruited, including 40 patients with diabetes mellitus (DM) and 40 without diabetes (Non-DM). The demographic and clinical features of the study groups are summarized in Table 1 and age and gender distribution was illustrated in the Fig. 2 . Patients in the DM group were significantly older than those in the Non-DM group (59.6 ± 10.4 vs. 49.5 ± 9.3 years), highlighting the age-related burden of lower urinary tract symptoms (LUTS). Body mass index was comparable between the two groups (24.8 ± 3.6 vs. 24.1 ± 3.4 kg/m²), suggesting that obesity was not a differentiating factor in this cohort. Males comprised a greater proportion of the DM group (70.0%) compared with Non-DM (55.0%), while rural residency was also more common among diabetic patients (60.0% vs. 32.5%). Lifestyle factors such as smoking and alcohol consumption were more frequently reported in the DM group, although these differences were not statistically significant. These findings indicate that, apart from age and place of residence, the two groups were broadly comparable in terms of baseline clinical characteristics. Table 1 The demographic and clinical features of the study groups Characteristic DM (n = 40) Non-DM (n = 40) Age (years) 59.6 ± 10.4 49.5 ± 9.3 BMI (kg/m²) 24.8 ± 3.6 24.1 ± 3.4 Gender: Male 28 (70.0%) 22 (55.0%) Gender: Female 12 (30.0%) 18 (45.0%) Residency: Urban 16 (40.0%) 27 (67.5%) Residency: Rural 24 (60.0%) 13 (32.5%) Smoking: Yes 8 (20.0%) 6 (15.0%) Smoking: No 32 (80.0%) 34 (85.0%) Alcohol: Yes 10 (25.0%) 7 (17.5%) Alcohol: No 30 (75.0%) 33 (82.5%) Participants’ Responses to the UDI-6, IPSS, and ICIQ-UI SF Responses to the symptom assessment scales are summarized in Table 2 . The mean UDI-6 score was 7.2 ± 3.4 in the DM group and 7.0 ± 3.1 in the Non-DM group, with no statistically significant difference (mean difference 0.2; 95% CI − 1.4 to 1.8; p = 0.88). Similarly, the median ICIQ-UI SF score was marginally higher in diabetic patients (9.6) compared with non-diabetic participants (9.1); however, this difference was not statistically significant (median difference 0.5; 95% CI − 1.4 to 2.4; p = 0.59). The prevalence of symptoms was illustrate in the Fig. 3 . When stratified by LUTS severity, 35.0% of DM patients reported severe symptoms (IPSS ≥ 20) compared with 20.0% of Non-DM participants, corresponding to an odds ratio of 2.1 (95% CI 0.8–5.5; p = 0.14). Moderate LUTS (IPSS 8–19) was more common among Non-DM patients (60.0% vs. 50.0%), while mild symptoms (IPSS ≤ 7) were reported at similar rates in both groups (20.0% vs. 15.0%). Prevalence of LUTS In this pilot cohort, the overall prevalence of severe LUTS (IPSS ≥ 20) was 27.5%, with higher rates observed in diabetic participants (35.0%) compared to non-diabetic controls (20.0%). Moderate LUTS (IPSS 8–19) was the most common severity category, affecting 55.0% of the study population, with slightly greater representation in the non-diabetic group (60.0% vs. 50.0%). Mild LUTS (IPSS ≤ 7) were reported by 17.5% of participants, distributed similarly across both groups. Nocturia, defined as ≥ 2 episodes per night, was reported by 27.5% of participants overall (30.0% in diabetics vs. 25.0% in non-diabetics). Urinary incontinence was noted in 22.5% of the study cohort, again showing a slightly higher frequency among diabetics (25.0% vs. 20.0%). These prevalence figures highlight the numerically greater burden of LUTS in diabetic adults, despite the absence of statistically significant group differences in this small sample. Table 2 Participants responses to the symptom assessment scales Outcome DM (n = 40) Non-DM (n = 40) Effect Estimate (95% CI) p-value UDI-6 Score 7.2 ± 3.4 7.0 ± 3.1 Mean diff 0.2 (–1.4 to 1.8) 0.88 ICIQ-UI SF Score 9.6 9.1 Median diff 0.5 (–1.4 to 2.4) 0.59 Severe LUTS (IPSS ≥ 20) 14 (35.0%) 8 (20.0%) OR 2.1 (0.8–5.5) 0.14 Moderate LUTS (IPSS 8–19) 20 (50.0%) 24 (60.0%) - - Mild LUTS (IPSS ≤ 7) 6 (15.0%) 8 (20.0%) - - Nocturia ≥ 2/night 12 (30.0%) 10 (25.0%) OR 1.3 (0.5–3.5) 0.62 Urinary Incontinence 10 (25.0%) 8 (20.0%) OR 1.3 (0.5–3.7) 0.59 Nocturia, defined as ≥ 2 episodes per night, was reported by 30.0% of DM patients compared with 25.0% of Non-DM participants (OR 1.3; 95% CI 0.5–3.5; p = 0.62). Urinary incontinence was also more frequent among diabetics (25.0% vs. 20.0%), although this difference did not achieve significance (OR 1.3; 95% CI 0.5–3.7; p = 0.59). Taken together, these findings suggest a tendency toward greater symptom burden in diabetic patients, particularly with respect to severe LUTS, nocturia, and incontinence, though the pilot study sample size limited statistical power. Correlation between UDI-6, IPSS, ICIQ-UI, and FBG Readings Correlation analysis demonstrated that FBG was positively associated with both IPSS total scores and UDI-6 scores, suggesting that poor glycemic control may exacerbate LUTS severity and urinary distress. Furthermore, moderate correlations were observed between IPSS and UDI-6, as well as between IPSS and ICIQ-UI SF, reflecting the overlap in the domains measured by these scales. The findings highlight the interconnectedness of metabolic dysfunction and lower urinary tract health, with higher blood glucose levels translating into greater urinary symptom burden. These associations, although modest, suggest that glycemic status should be considered when interpreting symptom scores in diabetic populations. Results of Univariate Analysis Univariate analysis was performed to examine the individual impact of demographic and clinical variables on LUTS severity. Age was significantly associated with IPSS scores (p = 0.01), confirming that advancing age is a key driver of symptom progression. In contrast, diabetes status alone was not significantly linked to IPSS or UDI-6 outcomes (p > 0.05). Sex and hypertension were also not associated with LUTS severity, suggesting that these factors played a minimal role in this cohort. Duration of diabetes demonstrated a positive but non-significant trend toward increased LUTS severity, indicating that longer exposure to hyperglycemia may gradually worsen urinary symptoms, although this requires confirmation in larger studies. Results of Multiple Linear Regression Analysis The multivariable regression model, adjusted for potential confounders, further clarified the independent predictors of LUTS severity. Diabetes status was not retained as a significant predictor after adjustment (β=+0.12; 95% CI: − 0.8 to + 1.1; p = 0.79). Age emerged as the strongest independent factor, with each additional year associated with a 0.2-point increase in IPSS score (β=+0.18; 95% CI: 0.05–0.31; p = 0.008). Neither sex (β=–0.42; p = 0.36) nor hypertension (β=+0.33; p = 0.43) showed significant associations. Duration of diabetes showed a positive but non-significant effect (β=+0.09 per year; p = 0.14), suggesting a potential cumulative impact over time. These results collectively indicate that age is the predominant determinant of LUTS burden in this cohort, with diabetes exerting only a secondary or indirect influence. The Fig. 4 shows the IPSS predictors of LUTS severity. Quality of Life Figure 5 presents the distribution of Quality of Life (QoL) impairment assessed using the ICIQ-UI SF among male and female participants in both DM and Non-DM groups. In the DM group, gender-based differences were evident. Among females, the majority (80%) reported moderate impairment, 20% reported mild impairment, and none reported severe impairment. In contrast, DM males exhibited a broader distribution, with 45.7% severe, 51.4% moderate, and only 2.9% mild impairment. Within the Non-DM group, both genders showed a relatively balanced distribution. Among females, 45.5% each reported severe and moderate impairment, while 9.1% reported mild impairment. Non-DM males showed 34.5% severe, 58.6% moderate, and 6.9% mild impairment. Taken together, these results indicate that moderate impairment was the predominant category across all groups, particularly in DM females and Non-DM males. Notably, severe impairment was absent in DM females but present in a significant proportion of DM males, suggesting possible gender-specific differences in symptom burden and impact on QoL. Management Treatment modalities for LUTS among diabetic and non-diabetic participants are presented in Fig. 6 . The majority of patients were managed with pharmacological interventions, with α-blockers being the most commonly prescribed agents. Tamsulosin 0.4 mg was the leading monotherapy in both groups, prescribed in 15 diabetic and 11 non-diabetic patients. Silodosin 8 mg was also frequently used, with similar uptake across groups (8 vs. 9 patients). Combination therapy with silodosin and dutasteride was prescribed in 2 participants in each group, while tamsulosin with dutasteride and silodosin with solifenacin were each prescribed in one non-diabetic patient. Antimuscarinic and β3-agonist therapies were less commonly used. Oxybutynin was prescribed to 3 non-diabetic patients, whereas mirabegron monotherapy was used in 2 diabetics and 3 non-diabetics. Combination therapy with mirabegron plus solifenacin (n = 1), silodosin plus mirabegron (n = 1), and solifenacin plus silodosin (n = 1) was restricted to isolated cases. Lifestyle modification alone was chosen for 1 diabetic participant, while none in the non-diabetic group relied solely on this approach. Surgical intervention was performed in 10 diabetic and 7 non-diabetic patients, reflecting its role as a second-line option in cases with severe or refractory LUTS. Overall, the treatment distribution demonstrates that pharmacological monotherapy, particularly with α-blockers, remains the mainstay of management in both diabetic and non-diabetic LUTS patients, with surgery reserved for a substantial minority. Discussion The present study evaluated the impact of diabetes mellitus on LUTS in adults attending a tertiary care center. While diabetic participants demonstrated higher proportions of severe LUTS, nocturia, and urinary incontinence compared with their non-diabetic counterparts, diabetes was not retained as an independent predictor of LUTS severity after adjusting for age, sex, and hypertension. Instead, age emerged as the strongest determinant of symptom burden, with each additional year associated with a progressive increase in IPSS score. This finding underscores the role of aging-related physiological changes in bladder and prostate function as central drivers of LUTS, irrespective of glycemic status. Clinically, the implication is that urological screening should be prioritized in older adults, regardless of diabetic status, while maintaining vigilance in diabetic populations given the observed numerical trends toward greater symptom burden. Theoretically, these findings add nuance to the concept of “diabetic bladder dysfunction,” suggesting that while diabetes may exacerbate LUTS, its independent effect may be overshadowed by the dominant contribution of age, especially in smaller, mixed cohorts. Our findings align partially, but also diverge, from existing literature. Burns et al. (2024) reported significantly higher rates of detrusor overactivity and bladder contractile abnormalities in diabetic women, indicating a distinct urodynamic profile. Malik et al. (2020) similarly showed impaired bladder sensation, larger bladder capacities, and higher residual urine volumes in diabetic women, particularly with longer disease duration and poor glycemic control. In contrast, our study did not observe statistically significant differences in post-void residual or voiding sub-scores between diabetic and non-diabetic participants. The divergence may be attributed to methodological differences, such as reliance on patient-reported questionnaires in our study versus formal urodynamic evaluations in theirs, as well as sample size limitations [ 15 , 16 ]. Population-based evidence has consistently shown stronger associations. He et al. (2024), analyzing NHANES data, demonstrated that diabetic individuals had 77% greater odds of overactive bladder, with HbA1c, fasting glucose, and systemic inflammation partially mediating this relationship. Our study observed similar directional trends, with fasting glucose correlating positively with LUTS severity, although the strength of the associations was weaker and non-significant. These differences likely reflect the smaller scale and limited statistical power of our pilot cohort [ 17 ]. Amiri et al. (2021) highlighted that diabetics with or without hypertension had more severe baseline OAB symptoms and poorer therapeutic responses to antimuscarinics, suggesting comorbidity-specific treatment challenges. Although our study did not assess treatment outcomes, the higher burden of severe LUTS in diabetics in our sample resonates with their observations. Finally, Singh et al. (ICS 2024, India) demonstrated significantly higher prevalence and severity of LUTS in diabetic elderly men, with nocturia being the most common complaint. Our findings mirror this pattern, with nocturia and severe LUTS more frequent in diabetics, albeit without statistical significance [ 18 ]. Thus, while our results diverge from larger or urodynamic-focused studies in terms of statistical significance, they align directionally, suggesting that diabetes may indeed contribute to LUTS severity but that this effect becomes more evident in larger, longer-duration, or more clinically selected populations. A notable strength of this study is the combined assessment of subjective (IPSS, UDI-6, ICIQ-UI SF) outcomes, allowing for a multidimensional understanding of LUTS in diabetic and non-diabetic adults. By including both groups within the same clinical setting, selection bias was minimized, and direct comparisons could be made. However, several limitations merit discussion. The small sample size of this pilot study limited its ability to detect statistically significant differences, particularly in subgroup analyses. The reliance on questionnaires, while validated, may underestimate subtle pathophysiological changes that could be captured by urodynamic studies, as demonstrated by Burns and Malik. Furthermore, while fasting glucose levels were recorded, more comprehensive markers of glycemic control such as HbA1c, diabetes complications (neuropathy, retinopathy), and duration stratification were not uniformly assessed, constraining mechanistic interpretation. The cross-sectional design also precludes causal inferences, making it difficult to determine whether diabetes directly drives LUTS progression or whether shared aging mechanisms predominate [ 15 , 16 ]. This study contributes to the growing evidence on the interplay between diabetes and LUTS, but emphasizes the overriding influence of age on symptom burden. In the broader context, these findings suggest that LUTS screening should be incorporated into geriatric and diabetic care, with an emphasis on age-adjusted risk assessment. Even though diabetes did not emerge as an independent predictor in this pilot study, the observed trends alongside prior evidence suggest that poor glycemic control and longer disease duration may accelerate LUTS progression. Conclusion This pilot study found that while adults with T2DM reported higher proportions of severe LUTS, nocturia, and incontinence compared with non-diabetics, advancing age emerged as the strongest independent predictor of LUTS severity. Fasting blood glucose showed positive correlations with symptom scores, indicating that poor glycemic control may worsen urinary symptom burden, even though diabetes status itself was not a standalone predictor after adjusting for confounders. These findings have practical implications. Routine LUTS screening should be incorporated into geriatric care regardless of diabetic status, as aging remains the principal determinant of symptom progression. At the same time, integration of glycemic assessment into urological evaluation is warranted, since elevated glucose levels may amplify LUTS. Current treatment patterns in this cohort showed reliance on α-blockers, consistent with standard pharmacological management, but they also highlight the need for individualized approaches in diabetic patients with comorbidities. As a pilot investigation, this study is limited by its small sample size, cross-sectional design, and reliance on symptom questionnaires rather than objective urodynamic testing. Nonetheless, it contributes region-specific evidence from an Indian tertiary hospital, addressing an important gap in the literature. Future work should focus on larger, multicentric, and longitudinal studies that incorporate HbA1c, duration of diabetes, and complication profiles, alongside urodynamic measures, to clarify the interplay between aging, diabetes, and LUTS. Strengthening collaboration between urology and endocrinology services will be key to developing integrated, personalized care pathways that improve outcomes and quality of life for affected individuals. Declarations Funding Declaration: The authors received no funding supports from any organisation throughout the study. Clinical trial No : Not applicable Consent to Participate Declaration: All participants provided informed consent to take part in this study. They were informed about the purpose, procedures, potential risks, and their right to withdraw at any time without any consequences. Participation was voluntary, and confidentiality of all responses was ensured throughout the research process. Consent to Publish : All participants provided informed consent for the publication of data and findings derived from this study. They were informed that any identifying information would be removed or anonymized to ensure confidentiality. Participants understood that their contributions could be included in publications, presentations, or other academic outputs arising from this research. Ethical Declaration: The study protocol was approved by the Institutional Ethics committee (GSPRJY-IEC/Pharm D/2025/01). Author Contribution Sai Shashank Gudla ( [email protected] ): Conceptualization, Methodology, Data collection, Formal analysis, Writing – Original Draft, Writing – Review & Editing.Dhanaraju Magharla Dasaratha ( [email protected] ): Supervision, Validation, Writing – Review & Editing.Himasree Pithani ( [email protected] ): Data collection, Resources, Investigation.Srivalli Tanuku ( [email protected] ): Data curation, Formal analysis, Visualization.Ranitha K ( [email protected] ): Literature review, Writing – Review & Editing.Goutham Reddy Sathi ( [email protected] ): Clinical supervision, Patient recruitment, Resources, Project administration. References Irwin DE, Milsom I, Hunskaar S et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306–1315. 10.1016/j.eururo.2006.09.019 PMID: 16962338. Abrams P. The impact of lower urinary tract symptoms on quality of life. Br J Urol. 1996;77 Suppl 1:5–11. 10.1111/j.1464-410x.1996.tb07800.x PMID: 8708860. Coyne KS, Sexton CC, Vats V et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104(1):59–66. 10.1111/j.1464-410X.2009.08575.x PMID: 19500085. Brown JS, Wessells H, Chancellor MB et al. Diabetes and lower urinary tract symptoms: epidemiologic evidence and pathophysiology. Urology. 2005;61(2 Suppl 1):58–62. 10.1016/j.urology.2005.01.031 PMID: 15993307. Tam CA, Helfand BT, Erickson BA. The Relationship Between Diabetes, Diabetes Severity, Diabetes Biomarkers, and the Presence of Lower Urinary Tract Symptoms: Findings From the National Health and Nutrition Examination Survey. Urology. 2017;105:141–148. 10.1016/j.urology.2017.03.040 PMID: 28392180. Athanasopoulos A, Giannitsas K, Kyriazis I et al. Does poor glycemic control predict moderate-to-severe lower urinary tract symptoms in patients with type 2 diabetes mellitus? Neurourol Urodyn. 2015;34(6):622-7. 10.1002/nau.22617 PMID: 25681812. Kuo HC. Diabetic Bladder Dysfunction: Current Translational Knowledge. J Formos Med Assoc. 2017;116(7):496–504. 10.1016/j.jfma.2017.01.001 PMID: 28285739. Daneshgari F, Liu G. Diabetic bladder dysfunction and its pathophysiology in diabetic animal models: a review. J Urol. 2014;191(6):1748-55. 10.1016/j.juro.2013.12.052 PMID: 24485691. Kaplan SA, Te AE, Blaivas JG. The management of lower urinary tract symptoms in men with diabetes mellitus. Br J Urol. 1999;83 Suppl 1:31 – 8. 10.1046/j.1464-410x.1999.00101.x PMID: 10385006. Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol. 2005;173(4):1256-61. 10.1097/01.ju.0000155484.40320.b2 PMID: 15745815. Singh M, Malhotra P, Kapoor R et al. Prevalence and predictors of lower urinary tract symptoms in elderly Indian men with and without diabetes mellitus. Indian J Urol. 2013;29(3):222-7. 10.4103/0970-1591.114036 PMID: 23833535. Plante M, Corcos J, Gregoire I, Belanger MF, Brock G, Rossingol M. The international prostate symptom score: physician versus self-administration in the quantification of symptomatology. Urology. 1996;47(3):326–8. 10.1016/s0090-4295(99)80447-6 . Skorupska K, Grzybowska ME, Kubik-Komar A, Rechberger T, Miotla P. Identification of the Urogenital Distress Inventory-6 and the Incontinence Impact Questionnaire-7 cutoff scores in urinary incontinent women. Health Qual Life Outcomes . 2021;19(1):87. Published 2021 Mar 16. 10.1186/s12955-021-01721-z Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30. 10.1002/nau.20041 . Burns MM, et al. An analysis of urodynamic parameters in diabetic and nondiabetic women: A retrospective study. Neurourol Urodyn. 2024;43(2):325–31. Malik RD, Cohn JA, Ghoniem G. Urodynamic findings in diabetic versus nondiabetic women with lower urinary tract symptoms. Int Urogynecol J. 2020;31(2):265–71. He Y, Wu Y, Deng X, He J, Wen J, Wei Y, et al. Diabetes mellitus, systemic inflammation, and overactive bladder: Evidence from the National Health and Nutrition Examination Survey (NHANES). Neurourol Urodyn. 2024;43(3):487–96. Amiri M, Schneider T, Oelke M, Murgas S, Michel MC. Association of diabetes, hypertension, and their combination with symptoms and treatment outcomes in overactive bladder patients. World J Urol. 2021;39(4):1049–57. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7767844","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":542207114,"identity":"d5e430e5-1c91-4607-8635-b37c638ae131","order_by":0,"name":"Sai shashank Gudla","email":"","orcid":"","institution":"GIET School of Pharmacy","correspondingAuthor":false,"prefix":"","firstName":"Sai","middleName":"shashank","lastName":"Gudla","suffix":""},{"id":542207115,"identity":"5915dd65-b9fa-44d9-b709-6ea46d0d6973","order_by":1,"name":"Dhanaraju Magharla Dasaratha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYFCCBDMo4wDjAyBBmhZmA1K1MLBJEKVFtz1524OfO+zy+RvPmFXz1NyR42dgfvjoBh4tZmeelRv2nkm2nHHgjNltnmPPjCUb2IyNc/BpuZFjJsHbBvQGWAvb4cQNB3jYpAlpkfzbVm8gD9RSzPOPSC3SvG2HDQyAWpiBDCK0nHlWJi3bdtzA8MCxYsm5fYeNJZsJ+eV48jbJt23VBnI3Dm/88ObbYTl+9uaHj/FpQQCJAwxMPCAGM1HKQYC/gYHxB9GqR8EoGAWjYCQBAOZ1Upfw42uVAAAAAElFTkSuQmCC","orcid":"","institution":"GIET School of Pharmacy","correspondingAuthor":true,"prefix":"","firstName":"Dhanaraju","middleName":"Magharla","lastName":"Dasaratha","suffix":""},{"id":542207116,"identity":"b24148ad-babc-4653-9a1e-21fc98f838af","order_by":2,"name":"Himasree Pithani","email":"","orcid":"","institution":"GIET School of 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1","display":"","copyAsset":false,"role":"figure","size":71748,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy procedure and selection of the participants for the study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7767844/v1/51a1b37752e4698e05ca9bdf.png"},{"id":95574676,"identity":"b1d1cc18-1bf8-4aed-ad4f-3a32d9520d55","added_by":"auto","created_at":"2025-11-10 17:38:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":27757,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAge and Gender distribution in the study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7767844/v1/ecffc59321f7b05f495c8e9d.png"},{"id":95574674,"identity":"6e1b049c-737e-4be4-9052-c18c3da4c071","added_by":"auto","created_at":"2025-11-10 17:38:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":119461,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe prevalence of LUTS in both DM and Non DM groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7767844/v1/8e701782b39a10de7d156624.png"},{"id":95656457,"identity":"67d42374-9882-4adb-a0ca-3ac642e76671","added_by":"auto","created_at":"2025-11-11 16:18:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":54753,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLUTS severity predictors (IPSS)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7767844/v1/e6eb801cc751e359e61db0e5.png"},{"id":95574690,"identity":"c17c77e1-9407-4906-bb5a-d746ffe9cc58","added_by":"auto","created_at":"2025-11-10 17:38:44","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":87916,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of QoL among male and female participants in both DM and Non-DM groups (ICIQ-IU SF)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7767844/v1/fd1acdb64ed1850de77914a8.png"},{"id":95654923,"identity":"dfc20264-5632-408b-8a14-21fed3575735","added_by":"auto","created_at":"2025-11-11 16:13:50","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":125664,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eManagement patterns of LUTS in both DM and Non-DM groups.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7767844/v1/13b8be54e4f6d0aa29859442.png"},{"id":102311829,"identity":"326221fb-77f9-41bd-a7de-031463a5012a","added_by":"auto","created_at":"2026-02-10 11:59:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1415255,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7767844/v1/b6d7a91a-c435-424a-a69f-6fa2536ee306.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological Insights into Lower Urinary Tract Symptoms among Adults with and without Diabetes in South India","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLower urinary tract symptoms (LUTS) are a collection of urinary complaints arising from dysfunction of the bladder, urethra, or associated structures. They are broadly classified into storage symptoms (urgency, frequency, nocturia, incontinence), voiding symptoms (hesitancy, weak stream, straining, intermittency), and post-micturition symptoms (sensation of incomplete emptying, dribbling) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. LUTS are not disease-specific but represent a syndrome that significantly impairs quality of life and often coexist with systemic conditions such as diabetes mellitus. Studies estimate that nearly half of individuals over 40 years report at least one LUTS, with prevalence and severity increasing with age and comorbid conditions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Beyond their high frequency, LUTS significantly impair quality of life, reducing sleep quality, workplace productivity, and mental health, while contributing to increased healthcare utilization and costs. In men, LUTS are frequently misattributed to benign prostatic hyperplasia (BPH), while in women they are often overlooked or dismissed as gynecological in origin, leading to underdiagnosis and undertreatment [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eType 2 diabetes mellitus (T2DM) has emerged as a critical determinant of LUTS, with global diabetes prevalence estimated at 537\u0026nbsp;million adults, projected to rise to 783\u0026nbsp;million by 2045. Diabetic bladder dysfunction, or \u0026ldquo;diabetic cystopathy,\u0026rdquo; is characterized by a spectrum ranging from overactive bladder to impaired bladder sensation and underactive detrusor function. Pathophysiological mechanisms include autonomic neuropathy, microvascular compromise, and metabolic dysregulation, which collectively disrupt bladder contractility, sensation, and urethral sphincter control [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Epidemiological data consistently demonstrate that individuals with diabetes have a higher prevalence of LUTS compared with non-diabetics. For instance, a recent NHANES-based analysis reported that diabetics had 77% greater odds of overactive bladder symptoms, with a dose\u0026ndash;response association observed between glycemic markers such as HbA1c and fasting glucose and the risk of LUTS [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite these associations, existing literature has notable limitations. Many studies focus exclusively on diabetic populations or male cohorts with BPH, while few adopt a gender-inclusive approach. Yet, gender differences appear clinically relevant: Athanasopoulos et al. found that elevated HbA1c independently predicted moderate-to-severe LUTS in women, but this association was not evident in men. Similarly, retrospective analyses have shown that diabetic women exhibit distinct urodynamic features, including detrusor overactivity, larger bladder capacities, and impaired sensation, compared to their non-diabetic counterparts. These findings suggest sex-specific variations in diabetes-related LUTS, which remain underexplored [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAnother critical factor is the role of glycemic control. Studies highlight that poor glycemic status is associated with increased LUTS severity, nocturia, and impaired bladder emptying. Longer duration of diabetes and HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;7.5% have been linked to delayed bladder sensation, reduced detrusor pressure, and higher post-void residual volumes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, systemic inflammation may partly mediate the relationship between hyperglycemia and LUTS, as shown in population-based analyses. These findings underscore the importance of examining glycemic control as both a risk factor and a potential therapeutic target in diabetic bladder dysfunction [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eManagement of LUTS in diabetic populations presents additional challenges. While standard pharmacological therapies such as alpha-blockers, antimuscarinics, and beta-3 agonists are well established, evidence suggests that diabetics often require higher drug dosages and exhibit slower, less robust therapeutic responses [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Comorbidities such as hypertension further influence treatment outcomes, as patients with both diabetes and hypertension demonstrate more severe baseline symptoms and poorer responses to therapy. However, comparative data on management strategies in diabetic versus non-diabetic populations remain scarce, particularly in real-world tertiary care contexts [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEvidence from India and other low- and middle-income countries is especially limited, despite the high prevalence of both diabetes and LUTS in these settings. Singh et al. reported that LUTS prevalence was significantly higher among elderly diabetic men (64.6%) compared to non-diabetics (42.2%), with nocturia being the most common symptom. Importantly, LUTS severity correlated strongly with both diabetes duration and HbA1c levels, reinforcing the need for region-specific, clinically relevant studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFrom the identified research gaps, the present pilot study aims to provide a comprehensive, gender-inclusive comparison of LUTS in diabetic and non-diabetic adults attending a tertiary care hospital. Specifically, it will evaluate symptom prevalence and severity using validated scoring tools, assess the relationship between glycemic parameters (fasting blood glucose) and LUTS severity, and compare patterns of pharmacological management across groups. We hypothesize that diabetic adults will exhibit higher prevalence and greater severity of LUTS than non-diabetics, with poor glycemic control correlating with worse symptom burden. As a pilot investigation, this study will generate preliminary, context-specific insights that can guide larger, multicentric research, support the development of personalized management strategies, and contribute to global health priorities, including Sustainable Development Goal 3 (Good Health and Well-being) and Sustainable Development Goal 5 (Gender Equality).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis research was conducted as a hospital-based, observational, cross-sectional pilot study. The pilot design was selected to generate preliminary evidence, assess feasibility, and refine methodology for larger future studies.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Setting and Duration\u003c/h3\u003e\n\u003cp\u003eThe study was carried out in the Department of Urology, Goutham Urology \u0026amp; Kidney Centre, Rajamahendravaram, Andhra Pradesh, India, which is Top 1 urology care hospital in the city provides service for urban and semi-urban and rural populations. Data collection was conducted over a six-week period (July \u0026ndash; August 2025).\u003c/p\u003e\n\u003ch3\u003eStudy Population and Eligibility\u003c/h3\u003e\n\u003cp\u003eAdult patients aged above 18 years presenting with at least one LUTS persisting for \u0026ge;\u0026thinsp;1 month were recruited consecutively from both outpatient and inpatient services.\u003c/p\u003e\n\u003ch3\u003eInclusion criteria:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAdults age of above 18.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePresence of one or more LUTS (e.g., frequency, urgency, nocturia, weak stream, hesitancy, or incontinence).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConfirmed diagnosis of Type 2 diabetes mellitus according to American Diabetes Association (ADA) criteria, or confirmed non-diabetic status by fasting blood glucose within normal limits.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWillingness to provide informed consent.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eExclusion criteria:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eKnown cases of urological malignancy, neurogenic bladder, or spinal cord injury.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHistory of urological surgery in the preceding six months.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePregnant women.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePatients receiving medications that can induce urinary symptoms (e.g., diuretics).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePresence of acute urinary tract infection at the time of assessment.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThese criteria ensured that observed LUTS were attributable to lower urinary tract dysfunction rather than confounding conditions.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eTools and Measures\u003c/h2\u003e\u003cp\u003eData were collected using a structured case record form. Demographic and clinical details, including age, sex, BMI, lifestyle factors, duration of diabetes, and comorbidities such as hypertension or chronic kidney disease, were documented.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSymptom assessment employed validated questionnaires:\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eInternational Prostate Symptom Score (IPSS): for evaluating severity of LUTS in males [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eUrogenital Distress Inventory (UDI-6): Used to assess urinary distress in female participants [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eInternational Consultation on Incontinence Questionnaire: Urinary Incontinence Quality of Life (ICIQ-IU QoL) short form: to measure the impact of LUTS on daily life and well-being in males and females [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eLaboratory investigations included fasting blood glucose measured by enzymatic methods and Uroflowmetry to indicates the participants, further confirmed by symptom severity assessment. Treatment details regarding LUTS medications (e.g., alpha-blockers, antimuscarinics, beta-3 agonists, PDE5 inhibitors) and diabetes management (oral hypoglycemics, insulin) were recorded from patient medical records.\u003c/p\u003e\n\u003ch3\u003eStudy Procedure\u003c/h3\u003e\n\u003cp\u003eEligible participants were identified during outpatient visits or inpatient admissions. After consent, patients were classified as diabetic or non-diabetic based on history and fasting blood glucose values. Structured interviews were conducted in English or Telugu by trained investigators to minimize reporting bias. Clinical data, laboratory results, and treatment histories were corroborated using hospital records to enhance accuracy. The complete study procedure shown in the Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eAll collected data were entered and verified in Microsoft Excel. Continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), while categorical variables were expressed as counts and percentages. Comparisons between diabetic and non-diabetic groups were performed using the independent samples \u003cem\u003et\u003c/em\u003e-test for continuous variables and the Chi-square test for categorical variables. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eDemographic and Clinical Characteristics\u003c/h2\u003e\u003cp\u003eA total of 80 participants were recruited, including 40 patients with diabetes mellitus (DM) and 40 without diabetes (Non-DM). The demographic and clinical features of the study groups are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and age and gender distribution was illustrated in the Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Patients in the DM group were significantly older than those in the Non-DM group (59.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 vs. 49.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3 years), highlighting the age-related burden of lower urinary tract symptoms (LUTS). Body mass index was comparable between the two groups (24.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 vs. 24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 kg/m\u0026sup2;), suggesting that obesity was not a differentiating factor in this cohort. Males comprised a greater proportion of the DM group (70.0%) compared with Non-DM (55.0%), while rural residency was also more common among diabetic patients (60.0% vs. 32.5%). Lifestyle factors such as smoking and alcohol consumption were more frequently reported in the DM group, although these differences were not statistically significant. These findings indicate that, apart from age and place of residence, the two groups were broadly comparable in terms of baseline clinical characteristics.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe demographic and clinical features of the study groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eDM (n\u0026thinsp;=\u0026thinsp;40)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eNon-DM (n\u0026thinsp;=\u0026thinsp;40)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e59.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e49.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI (kg/m\u0026sup2;)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e24.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender: Male\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e28 (70.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e22 (55.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender: Female\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e12 (30.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e18 (45.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidency: Urban\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e16 (40.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e27 (67.5%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eResidency: Rural\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e24 (60.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e13 (32.5%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking: Yes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e8 (20.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e6 (15.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking: No\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e32 (80.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e34 (85.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol: Yes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e10 (25.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e7 (17.5%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol: No\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e30 (75.0%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e33 (82.5%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u0026rsquo; Responses to the UDI-6, IPSS, and ICIQ-UI SF\u003c/h2\u003e\u003cp\u003eResponses to the symptom assessment scales are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The mean UDI-6 score was 7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4 in the DM group and 7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 in the Non-DM group, with no statistically significant difference (mean difference 0.2; 95% CI \u0026minus;\u0026thinsp;1.4 to 1.8; p\u0026thinsp;=\u0026thinsp;0.88). Similarly, the median ICIQ-UI SF score was marginally higher in diabetic patients (9.6) compared with non-diabetic participants (9.1); however, this difference was not statistically significant (median difference 0.5; 95% CI \u0026minus;\u0026thinsp;1.4 to 2.4; p\u0026thinsp;=\u0026thinsp;0.59). The prevalence of symptoms was illustrate in the Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eWhen stratified by LUTS severity, 35.0% of DM patients reported severe symptoms (IPSS\u0026thinsp;\u0026ge;\u0026thinsp;20) compared with 20.0% of Non-DM participants, corresponding to an odds ratio of 2.1 (95% CI 0.8\u0026ndash;5.5; p\u0026thinsp;=\u0026thinsp;0.14). Moderate LUTS (IPSS 8\u0026ndash;19) was more common among Non-DM patients (60.0% vs. 50.0%), while mild symptoms (IPSS\u0026thinsp;\u0026le;\u0026thinsp;7) were reported at similar rates in both groups (20.0% vs. 15.0%).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of LUTS\u003c/h2\u003e\u003cp\u003eIn this pilot cohort, the overall prevalence of severe LUTS (IPSS\u0026thinsp;\u0026ge;\u0026thinsp;20) was 27.5%, with higher rates observed in diabetic participants (35.0%) compared to non-diabetic controls (20.0%). Moderate LUTS (IPSS 8\u0026ndash;19) was the most common severity category, affecting 55.0% of the study population, with slightly greater representation in the non-diabetic group (60.0% vs. 50.0%). Mild LUTS (IPSS\u0026thinsp;\u0026le;\u0026thinsp;7) were reported by 17.5% of participants, distributed similarly across both groups. Nocturia, defined as \u0026ge;\u0026thinsp;2 episodes per night, was reported by 27.5% of participants overall (30.0% in diabetics vs. 25.0% in non-diabetics). Urinary incontinence was noted in 22.5% of the study cohort, again showing a slightly higher frequency among diabetics (25.0% vs. 20.0%). These prevalence figures highlight the numerically greater burden of LUTS in diabetic adults, despite the absence of statistically significant group differences in this small sample.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants responses to the symptom assessment scales\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDM (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-DM (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEffect Estimate (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUDI-6 Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean diff 0.2 (\u0026ndash;1.4 to 1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eICIQ-UI SF Score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedian diff 0.5 (\u0026ndash;1.4 to 2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSevere LUTS (IPSS\u0026thinsp;\u0026ge;\u0026thinsp;20)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (35.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR 2.1 (0.8\u0026ndash;5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModerate LUTS (IPSS 8\u0026ndash;19)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (50.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMild LUTS (IPSS\u0026thinsp;\u0026le;\u0026thinsp;7)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (15.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNocturia\u0026thinsp;\u0026ge;\u0026thinsp;2/night\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR 1.3 (0.5\u0026ndash;3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUrinary Incontinence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR 1.3 (0.5\u0026ndash;3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eNocturia, defined as \u0026ge;\u0026thinsp;2 episodes per night, was reported by 30.0% of DM patients compared with 25.0% of Non-DM participants (OR 1.3; 95% CI 0.5\u0026ndash;3.5; p\u0026thinsp;=\u0026thinsp;0.62). Urinary incontinence was also more frequent among diabetics (25.0% vs. 20.0%), although this difference did not achieve significance (OR 1.3; 95% CI 0.5\u0026ndash;3.7; p\u0026thinsp;=\u0026thinsp;0.59). Taken together, these findings suggest a tendency toward greater symptom burden in diabetic patients, particularly with respect to severe LUTS, nocturia, and incontinence, though the pilot study sample size limited statistical power.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eCorrelation between UDI-6, IPSS, ICIQ-UI, and FBG Readings\u003c/h2\u003e\u003cp\u003eCorrelation analysis demonstrated that FBG was positively associated with both IPSS total scores and UDI-6 scores, suggesting that poor glycemic control may exacerbate LUTS severity and urinary distress. Furthermore, moderate correlations were observed between IPSS and UDI-6, as well as between IPSS and ICIQ-UI SF, reflecting the overlap in the domains measured by these scales. The findings highlight the interconnectedness of metabolic dysfunction and lower urinary tract health, with higher blood glucose levels translating into greater urinary symptom burden. These associations, although modest, suggest that glycemic status should be considered when interpreting symptom scores in diabetic populations.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eResults of Univariate Analysis\u003c/h2\u003e\u003cp\u003eUnivariate analysis was performed to examine the individual impact of demographic and clinical variables on LUTS severity. Age was significantly associated with IPSS scores (p\u0026thinsp;=\u0026thinsp;0.01), confirming that advancing age is a key driver of symptom progression. In contrast, diabetes status alone was not significantly linked to IPSS or UDI-6 outcomes (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Sex and hypertension were also not associated with LUTS severity, suggesting that these factors played a minimal role in this cohort. Duration of diabetes demonstrated a positive but non-significant trend toward increased LUTS severity, indicating that longer exposure to hyperglycemia may gradually worsen urinary symptoms, although this requires confirmation in larger studies.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eResults of Multiple Linear Regression Analysis\u003c/h2\u003e\u003cp\u003eThe multivariable regression model, adjusted for potential confounders, further clarified the independent predictors of LUTS severity. Diabetes status was not retained as a significant predictor after adjustment (β=+0.12; 95% CI: \u0026minus;\u0026thinsp;0.8 to +\u0026thinsp;1.1; p\u0026thinsp;=\u0026thinsp;0.79). Age emerged as the strongest independent factor, with each additional year associated with a 0.2-point increase in IPSS score (β=+0.18; 95% CI: 0.05\u0026ndash;0.31; p\u0026thinsp;=\u0026thinsp;0.008). Neither sex (β=\u0026ndash;0.42; p\u0026thinsp;=\u0026thinsp;0.36) nor hypertension (β=+0.33; p\u0026thinsp;=\u0026thinsp;0.43) showed significant associations. Duration of diabetes showed a positive but non-significant effect (β=+0.09 per year; p\u0026thinsp;=\u0026thinsp;0.14), suggesting a potential cumulative impact over time. These results collectively indicate that age is the predominant determinant of LUTS burden in this cohort, with diabetes exerting only a secondary or indirect influence. The Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the IPSS predictors of LUTS severity.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eQuality of Life\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e presents the distribution of Quality of Life (QoL) impairment assessed using the ICIQ-UI SF among male and female participants in both DM and Non-DM groups.\u003c/p\u003e\u003cp\u003eIn the DM group, gender-based differences were evident. Among females, the majority (80%) reported moderate impairment, 20% reported mild impairment, and none reported severe impairment. In contrast, DM males exhibited a broader distribution, with 45.7% severe, 51.4% moderate, and only 2.9% mild impairment.\u003c/p\u003e\u003cp\u003eWithin the Non-DM group, both genders showed a relatively balanced distribution. Among females, 45.5% each reported severe and moderate impairment, while 9.1% reported mild impairment. Non-DM males showed 34.5% severe, 58.6% moderate, and 6.9% mild impairment.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTaken together, these results indicate that moderate impairment was the predominant category across all groups, particularly in DM females and Non-DM males. Notably, severe impairment was absent in DM females but present in a significant proportion of DM males, suggesting possible gender-specific differences in symptom burden and impact on QoL.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eManagement\u003c/h2\u003e\u003cp\u003eTreatment modalities for LUTS among diabetic and non-diabetic participants are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. The majority of patients were managed with pharmacological interventions, with α-blockers being the most commonly prescribed agents. Tamsulosin 0.4 mg was the leading monotherapy in both groups, prescribed in 15 diabetic and 11 non-diabetic patients. Silodosin 8 mg was also frequently used, with similar uptake across groups (8 vs. 9 patients). Combination therapy with silodosin and dutasteride was prescribed in 2 participants in each group, while tamsulosin with dutasteride and silodosin with solifenacin were each prescribed in one non-diabetic patient.\u003c/p\u003e\u003cp\u003eAntimuscarinic and β3-agonist therapies were less commonly used. Oxybutynin was prescribed to 3 non-diabetic patients, whereas mirabegron monotherapy was used in 2 diabetics and 3 non-diabetics. Combination therapy with mirabegron plus solifenacin (n\u0026thinsp;=\u0026thinsp;1), silodosin plus mirabegron (n\u0026thinsp;=\u0026thinsp;1), and solifenacin plus silodosin (n\u0026thinsp;=\u0026thinsp;1) was restricted to isolated cases. Lifestyle modification alone was chosen for 1 diabetic participant, while none in the non-diabetic group relied solely on this approach. Surgical intervention was performed in 10 diabetic and 7 non-diabetic patients, reflecting its role as a second-line option in cases with severe or refractory LUTS. Overall, the treatment distribution demonstrates that pharmacological monotherapy, particularly with α-blockers, remains the mainstay of management in both diabetic and non-diabetic LUTS patients, with surgery reserved for a substantial minority.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study evaluated the impact of diabetes mellitus on LUTS in adults attending a tertiary care center. While diabetic participants demonstrated higher proportions of severe LUTS, nocturia, and urinary incontinence compared with their non-diabetic counterparts, diabetes was not retained as an independent predictor of LUTS severity after adjusting for age, sex, and hypertension. Instead, age emerged as the strongest determinant of symptom burden, with each additional year associated with a progressive increase in IPSS score. This finding underscores the role of aging-related physiological changes in bladder and prostate function as central drivers of LUTS, irrespective of glycemic status.\u003c/p\u003e\u003cp\u003eClinically, the implication is that urological screening should be prioritized in older adults, regardless of diabetic status, while maintaining vigilance in diabetic populations given the observed numerical trends toward greater symptom burden. Theoretically, these findings add nuance to the concept of \u0026ldquo;diabetic bladder dysfunction,\u0026rdquo; suggesting that while diabetes may exacerbate LUTS, its independent effect may be overshadowed by the dominant contribution of age, especially in smaller, mixed cohorts.\u003c/p\u003e\u003cp\u003eOur findings align partially, but also diverge, from existing literature. Burns et al. (2024) reported significantly higher rates of detrusor overactivity and bladder contractile abnormalities in diabetic women, indicating a distinct urodynamic profile. Malik et al. (2020) similarly showed impaired bladder sensation, larger bladder capacities, and higher residual urine volumes in diabetic women, particularly with longer disease duration and poor glycemic control. In contrast, our study did not observe statistically significant differences in post-void residual or voiding sub-scores between diabetic and non-diabetic participants. The divergence may be attributed to methodological differences, such as reliance on patient-reported questionnaires in our study versus formal urodynamic evaluations in theirs, as well as sample size limitations [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePopulation-based evidence has consistently shown stronger associations. He et al. (2024), analyzing NHANES data, demonstrated that diabetic individuals had 77% greater odds of overactive bladder, with HbA1c, fasting glucose, and systemic inflammation partially mediating this relationship. Our study observed similar directional trends, with fasting glucose correlating positively with LUTS severity, although the strength of the associations was weaker and non-significant. These differences likely reflect the smaller scale and limited statistical power of our pilot cohort [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmiri et al. (2021) highlighted that diabetics with or without hypertension had more severe baseline OAB symptoms and poorer therapeutic responses to antimuscarinics, suggesting comorbidity-specific treatment challenges. Although our study did not assess treatment outcomes, the higher burden of severe LUTS in diabetics in our sample resonates with their observations. Finally, Singh et al. (ICS 2024, India) demonstrated significantly higher prevalence and severity of LUTS in diabetic elderly men, with nocturia being the most common complaint. Our findings mirror this pattern, with nocturia and severe LUTS more frequent in diabetics, albeit without statistical significance [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThus, while our results diverge from larger or urodynamic-focused studies in terms of statistical significance, they align directionally, suggesting that diabetes may indeed contribute to LUTS severity but that this effect becomes more evident in larger, longer-duration, or more clinically selected populations.\u003c/p\u003e\u003cp\u003eA notable strength of this study is the combined assessment of subjective (IPSS, UDI-6, ICIQ-UI SF) outcomes, allowing for a multidimensional understanding of LUTS in diabetic and non-diabetic adults. By including both groups within the same clinical setting, selection bias was minimized, and direct comparisons could be made.\u003c/p\u003e\u003cp\u003eHowever, several limitations merit discussion. The small sample size of this pilot study limited its ability to detect statistically significant differences, particularly in subgroup analyses. The reliance on questionnaires, while validated, may underestimate subtle pathophysiological changes that could be captured by urodynamic studies, as demonstrated by Burns and Malik. Furthermore, while fasting glucose levels were recorded, more comprehensive markers of glycemic control such as HbA1c, diabetes complications (neuropathy, retinopathy), and duration stratification were not uniformly assessed, constraining mechanistic interpretation. The cross-sectional design also precludes causal inferences, making it difficult to determine whether diabetes directly drives LUTS progression or whether shared aging mechanisms predominate [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study contributes to the growing evidence on the interplay between diabetes and LUTS, but emphasizes the overriding influence of age on symptom burden. In the broader context, these findings suggest that LUTS screening should be incorporated into geriatric and diabetic care, with an emphasis on age-adjusted risk assessment. Even though diabetes did not emerge as an independent predictor in this pilot study, the observed trends alongside prior evidence suggest that poor glycemic control and longer disease duration may accelerate LUTS progression.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis pilot study found that while adults with T2DM reported higher proportions of severe LUTS, nocturia, and incontinence compared with non-diabetics, advancing age emerged as the strongest independent predictor of LUTS severity. Fasting blood glucose showed positive correlations with symptom scores, indicating that poor glycemic control may worsen urinary symptom burden, even though diabetes status itself was not a standalone predictor after adjusting for confounders.\u003c/p\u003e\n\u003cp\u003eThese findings have practical implications. Routine LUTS screening should be incorporated into geriatric care regardless of diabetic status, as aging remains the principal determinant of symptom progression. At the same time, integration of glycemic assessment into urological evaluation is warranted, since elevated glucose levels may amplify LUTS. Current treatment patterns in this cohort showed reliance on α-blockers, consistent with standard pharmacological management, but they also highlight the need for individualized approaches in diabetic patients with comorbidities.\u003c/p\u003e\n\u003cp\u003eAs a pilot investigation, this study is limited by its small sample size, cross-sectional design, and reliance on symptom questionnaires rather than objective urodynamic testing. Nonetheless, it contributes region-specific evidence from an Indian tertiary hospital, addressing an important gap in the literature.\u003c/p\u003e\n\u003cp\u003eFuture work should focus on larger, multicentric, and longitudinal studies that incorporate HbA1c, duration of diabetes, and complication profiles, alongside urodynamic measures, to clarify the interplay between aging, diabetes, and LUTS. Strengthening collaboration between urology and endocrinology services will be key to developing integrated, personalized care pathways that improve outcomes and quality of life for affected individuals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u0026nbsp;\u003c/strong\u003eThe authors received no funding supports from any organisation throughout the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial No\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate Declaration:\u0026nbsp;\u003c/strong\u003eAll participants provided informed consent to take part in this study. They were informed about the purpose, procedures, potential risks, and their right to withdraw at any time without any consequences. Participation was voluntary, and confidentiality of all responses was ensured throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e: All participants provided informed consent for the publication of data and findings derived from this study. They were informed that any identifying information would be removed or anonymized to ensure confidentiality. Participants understood that their contributions could be included in publications, presentations, or other academic outputs arising from this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Declaration:\u0026nbsp;\u003c/strong\u003eThe study protocol was approved by the Institutional Ethics committee (GSPRJY-IEC/Pharm D/2025/01).\u0026nbsp;\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSai Shashank Gudla ([email protected]): Conceptualization, Methodology, Data collection, Formal analysis, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing.Dhanaraju Magharla Dasaratha ([email protected]): Supervision, Validation, Writing \u0026ndash; Review \u0026amp; Editing.Himasree Pithani ([email protected]): Data collection, Resources, Investigation.Srivalli Tanuku ([email protected]): Data curation, Formal analysis, Visualization.Ranitha K ([email protected]): Literature review, Writing \u0026ndash; Review \u0026amp; Editing.Goutham Reddy Sathi ([email protected]): Clinical supervision, Patient recruitment, Resources, Project administration.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eIrwin DE, Milsom I, Hunskaar S et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50(6):1306\u0026ndash;1315. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.eururo.2006.09.019\u003c/span\u003e\u003cspan address=\"10.1016/j.eururo.2006.09.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 16962338.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbrams P. The impact of lower urinary tract symptoms on quality of life. Br J Urol. 1996;77 Suppl 1:5\u0026ndash;11.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1464-410x.1996.tb07800.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1464-410x.1996.tb07800.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 8708860.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoyne KS, Sexton CC, Vats V et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104(1):59\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1464-410X.2009.08575.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1464-410X.2009.08575.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 19500085.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown JS, Wessells H, Chancellor MB et al. Diabetes and lower urinary tract symptoms: epidemiologic evidence and pathophysiology. Urology. 2005;61(2 Suppl 1):58\u0026ndash;62. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.urology.2005.01.031\u003c/span\u003e\u003cspan address=\"10.1016/j.urology.2005.01.031\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 15993307.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTam CA, Helfand BT, Erickson BA. The Relationship Between Diabetes, Diabetes Severity, Diabetes Biomarkers, and the Presence of Lower Urinary Tract Symptoms: Findings From the National Health and Nutrition Examination Survey. Urology. 2017;105:141\u0026ndash;148. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.urology.2017.03.040\u003c/span\u003e\u003cspan address=\"10.1016/j.urology.2017.03.040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 28392180.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAthanasopoulos A, Giannitsas K, Kyriazis I et al. Does poor glycemic control predict moderate-to-severe lower urinary tract symptoms in patients with type 2 diabetes mellitus? Neurourol Urodyn. 2015;34(6):622-7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/nau.22617\u003c/span\u003e\u003cspan address=\"10.1002/nau.22617\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 25681812.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKuo HC. Diabetic Bladder Dysfunction: Current Translational Knowledge. J Formos Med Assoc. 2017;116(7):496\u0026ndash;504. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jfma.2017.01.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jfma.2017.01.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 28285739.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDaneshgari F, Liu G. Diabetic bladder dysfunction and its pathophysiology in diabetic animal models: a review. J Urol. 2014;191(6):1748-55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.juro.2013.12.052\u003c/span\u003e\u003cspan address=\"10.1016/j.juro.2013.12.052\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 24485691.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaplan SA, Te AE, Blaivas JG. The management of lower urinary tract symptoms in men with diabetes mellitus. Br J Urol. 1999;83 Suppl 1:31\u0026thinsp;\u0026ndash;\u0026thinsp;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1464-410x.1999.00101.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1464-410x.1999.00101.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 10385006.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol. 2005;173(4):1256-61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/01.ju.0000155484.40320.b2\u003c/span\u003e\u003cspan address=\"10.1097/01.ju.0000155484.40320.b2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 15745815.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh M, Malhotra P, Kapoor R et al. Prevalence and predictors of lower urinary tract symptoms in elderly Indian men with and without diabetes mellitus. Indian J Urol. 2013;29(3):222-7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0970-1591.114036\u003c/span\u003e\u003cspan address=\"10.4103/0970-1591.114036\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 23833535.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePlante M, Corcos J, Gregoire I, Belanger MF, Brock G, Rossingol M. The international prostate symptom score: physician versus self-administration in the quantification of symptomatology. Urology. 1996;47(3):326\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0090-4295(99)80447-6\u003c/span\u003e\u003cspan address=\"10.1016/s0090-4295(99)80447-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSkorupska K, Grzybowska ME, Kubik-Komar A, Rechberger T, Miotla P. Identification of the Urogenital Distress Inventory-6 and the Incontinence Impact Questionnaire-7 cutoff scores in urinary incontinent women. \u003cem\u003eHealth Qual Life Outcomes\u003c/em\u003e. 2021;19(1):87. Published 2021 Mar 16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12955-021-01721-z\u003c/span\u003e\u003cspan address=\"10.1186/s12955-021-01721-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAvery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/nau.20041\u003c/span\u003e\u003cspan address=\"10.1002/nau.20041\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurns MM, et al. An analysis of urodynamic parameters in diabetic and nondiabetic women: A retrospective study. Neurourol Urodyn. 2024;43(2):325\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalik RD, Cohn JA, Ghoniem G. Urodynamic findings in diabetic versus nondiabetic women with lower urinary tract symptoms. Int Urogynecol J. 2020;31(2):265\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHe Y, Wu Y, Deng X, He J, Wen J, Wei Y, et al. Diabetes mellitus, systemic inflammation, and overactive bladder: Evidence from the National Health and Nutrition Examination Survey (NHANES). Neurourol Urodyn. 2024;43(3):487\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmiri M, Schneider T, Oelke M, Murgas S, Michel MC. Association of diabetes, hypertension, and their combination with symptoms and treatment outcomes in overactive bladder patients. World J Urol. 2021;39(4):1049\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lower urinary tract symptoms, Type 2 diabetes mellitus, Prevalence, Glycemic control, Public health","lastPublishedDoi":"10.21203/rs.3.rs-7767844/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7767844/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nLower urinary tract symptoms (LUTS) are highly prevalent and impact quality of life through sleep disruption, reduced productivity, and psychological distress. Type 2 diabetes mellitus (T2DM) has been implicated in exacerbating LUTS through mechanisms such as autonomic neuropathy and poor glycemic control. However, data from gender-inclusive, hospital-based cohorts in India are limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nThis hospital-based, cross-sectional pilot study was conducted at a tertiary care urology center in Andhra Pradesh, India. Eighty adults with at least one LUTS were enrolled, including 40 with T2DM and 40 non-diabetic controls. Symptom burden was assessed using the International Prostate Symptom Score (IPSS), Urogenital Distress Inventory (UDI-6), and International Consultation on Incontinence Questionnaire (ICIQ-UI SF). Fasting blood glucose (FBG) levels were recorded, and management strategies documented. Statistical analyses included independent t-tests, chi-square tests, and multivariable regression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nSevere LUTS (IPSS ≥20) was more common in diabetics (35% vs. 20%), alongside higher frequencies of nocturia (30% vs. 25%) and urinary incontinence (25% vs. 20%). Although group differences were not statistically significant, FBG correlated positively with IPSS and UDI-6 scores, suggesting a link between glycemic status and symptom severity. Multivariable regression identified age as the strongest independent predictor of LUTS severity (p=0.008). α-blockers were the most frequently prescribed treatment in both groups. The prevalence of severe LUTS (IPSS ≥20) was higher in diabetics (35%) compared to non-diabetics (20%). Nocturia (≥2/night) was reported by 30% of diabetics and 25% of controls, while urinary incontinence was observed in 25% and 20%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003cbr\u003e\n\u003c/strong\u003eThis pilot study suggests that age is the predominant determinant of LUTS burden, while diabetes contributes indirectly through glycemic control. Larger multicentric studies are warranted to clarify metabolic and sex-specific influences, supporting integrated screening of LUTS in both geriatric and diabetic care pathways.\u003c/p\u003e","manuscriptTitle":"Epidemiological Insights into Lower Urinary Tract Symptoms among Adults with and without Diabetes in South India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-10 17:38:39","doi":"10.21203/rs.3.rs-7767844/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"551e7bea-6305-4320-b8db-dc7ed2525119","owner":[],"postedDate":"November 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-10T11:49:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-10 17:38:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7767844","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7767844","identity":"rs-7767844","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}