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Prevalence and Risk Factors for Bladder and Bowel Dysfunction in Children With Type 1 Diabetes
Kristen Favel1,2, Maryellen S Kelly3,4, Shing Tat Theodore Lam5,6
1Division of Pediatric Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
Insights
Children with type 1 diabetes (T1D) have a higher prevalence of bowel and bladder dysfunction (BBD) compared to healthy peers. Poor glycemic control is linked to BBD, emphasizing the need for early screening and intervention in pediatric T1D management.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Urology
Background:
- Urologic complications are common in adults with type 1 diabetes (T1D).
- Data on bowel and bladder dysfunction (BBD) in pediatric T1D is limited.
- This study addresses the prevalence, risk factors, and impact of BBD in children with T1D.
Purpose of the Study:
- To determine the prevalence of BBD in children with T1D versus healthy controls.
- To identify clinical factors associated with BBD in childhood T1D.
- To assess the bother associated with BBD symptoms in pediatric T1D.
Main Methods:
- Cross-sectional, multicenter survey of children aged 5-16 with T1D and controls.
- Vancouver Symptom Score (VSS) used to assess bowel and bladder symptoms.
- BBD defined as VSS score ≥ 11; logistic regression for risk factor analysis.
Main Results:
- BBD prevalence was 21.5% in T1D versus 10.5% in controls.
- Poorer glycemic control correlated with higher BBD likelihood in T1D.
- Urinary incontinence caused the most bother; male sex associated with greater symptom bother.
Conclusions:
- Pediatric T1D is associated with a significantly higher prevalence of BBD.
- Early identification and intervention for BBD are crucial in pediatric T1D.
- Comprehensive T1D management, including glycemic control, is vital for mitigating BBD burden.
Abstract:
Background: Urologic complications, including urinary incontinence and urinary tract infections are commonly observed in the adult population with type 1 diabetes (T1D); however, there remains a paucity of data on the prevalence, associated risk factors and impact of bowel and bladder dysfunction (BBD) in the pediatric T1D population. Aim: This study aims to examine the prevalence of BBD in children with T1D compared to healthy pediatric controls and to explore clinical factors associated with childhood BBD. Methods: This cross-sectional, noninterventional, multicenter survey study involved children with TID and healthy controls aged 5-16 years across North America. Participants and their caregivers completed the Vancouver Symptom Score (VSS) to assess bowel and bladder symptoms. BBD was defined as a total VSS score of 11 or greater. Logistic regression was used to identify potential factors associated with BBD and bother with symptoms. Results: In a group of 242 participants with T1D and 86 controls, 46% were male, and the median age was 11.0 years. The prevalence of BBD was found to be higher in participants with T1D at 21.5%, compared to 10.5% in controls. While irritative symptoms were most commonly reported in the T1D group with BBD, urinary incontinence caused the most bother. In the T1D group, poorer glycemic control was linked to a greater likelihood of BBD, while male sex and more severe symptomatology (such as urinary incontinence) were associated with greater bother related to these symptoms. Conclusion: There is a high prevalence of BBD in children with T1D compared to healthy controls. These data highlight the need for early identification and intervention for BBD in T1D. Proactive measures, such as routine screening and comprehensive T1D management with strict attention to glycemic control, are crucial to address the significant burden of BBD and improve overall health outcomes for children with T1D and their families.
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