Autonomic Symptom Burden and Urinary Incontinence Severity in Women with Type 2 Diabetes: A Cross-Sectional Study.

INTRODUCTION AND HYPOTHESIS: This study aimed to evaluate the association between autonomic symptom burden and urinary incontinence severity in women with type 2 diabetes. METHODS: This cross-sectional study was conducted at a diabetes center in Istanbul, Türkiye, and women aged 18-65 years with type 2 diabetes were included. Autonomic symptoms were assessed using the Composite Autonomic Symptom Score-31, and urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire-Short Form. Urinary incontinence was analyzed both as a binary outcome and by severity categories. Multivariable logistic regression was used to examine whether autonomic dysfunction was independently associated with urinary incontinence after adjustment for age, body mass index, diabetes duration, HbA1c, menopausal status, number of deliveries, diabetic neuropathy, and diuretic use. RESULTS: The study included 391 women. Urinary incontinence was present in 282 out of 391 women (71.9%). Urinary incontinence was more frequent among women with longer diabetes duration, constipation, nocturia, and combined vaginal and cesarean delivery history. Autonomic dysfunction increased markedly with urinary incontinence severity, from 23.9% in women with none/minimal urinary incontinence to 81.3% in those with very severe urinary incontinence. Orthostatic, gastrointestinal, bladder, and pupillomotor domain scores differed significantly across urinary incontinence severity groups. In multivariable analysis, autonomic dysfunction was independently associated with urinary incontinence (adjusted odds ratio: 2.00, 95% confidence interval: 1.26-3.18, p = 0.003). CONCLUSIONS: Autonomic dysfunction was independently associated with urinary incontinence in women with type 2 diabetes, and its prevalence increased substantially with symptom severity.