Diabetes Mellitus and Recurrent Urinary Tract Infections

Women with diabetes mellitus experience higher rates of urinary tract infections (UTIs) and recurrent UTIs, yet evidence-based guidance on risk factors and management in this population remains limited. Given that urogynecologists frequently evaluate women with recurrent UTI symptoms-many of whom also have diabetes-clarifying diabetes-specific risks is essential for guiding clinical decision making. This Clinical Consensus Statement reviews and summarizes existing evidence in a topic that is highly relevant to urogynecologists, who routinely manage women with recurrent UTI symptoms and diabetes mellitus.

A team of 7 urogynecologists and pelvic reconstructive surgeons conducted a systematic review of literature from January 1995 to October 2024, analyzing 249 abstracts and 119 full-text articles, ultimately including 32 studies. Initially aiming to create clinical guidelines, insufficient evidence led to the development of a Clinical Consensus Statement, which was revised using the Delphi method.

Consensus was reached on 7 of 11 statements in the first round, with the remaining 4 condensed into 2 final statements. Nine statements were developed and categorized into 3 areas: (1) epidemiology, (2) risk factors (glycemic control, glucose-lowering medications, and bacteriuria), and (3) prevention and treatment.

UTI and recurrent UTI prevalence are higher in women with diabetes mellitus, but there is a significant lack of prospective studies, including randomized trials, on the risks and side effects of medications related to lower UTIs in this population. Future studies assessing the efficacy of UTI prevention and treatment strategies specifically in women with diabetes mellitus are urgently needed.