Dr. Kenneth Thomas, MD Diabetes Support Group Starkville, MS 7/10/12

 25.8 million children and adults in the United States—8.3% of the population—have diabetes  10.9 million, or 26.9% of all people in the 65+ age group have diabetes  Average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes!

 Other Problems  Heart disease  Stroke  Neuropathy  Blindness  High blood pressure  Amputation  Elevated lipid profiles

 What we’ll talk about  Bladder Dysfunction – Anything from “I pee too much” to “I can’t pee”  Urinary Incontinence  BPH – older gentlemen with difficulty voiding  UTIs  ED

 What we’ll talk about  Hypogonadism – “Low T”  Diabetic Nephropathy – fancy words for the kidneys not working like they used to  Renal Transplantation  Surgery

 Over half of diabetics have bladder “issues”  Diabetic Cystopathy – poor bladder sensation, poor contractility and increased post-void residuals (increased incidence the longer a patient has had DM)  39-61% of patients have urgency +/- frequency

 What can diabetic cystopathy (elevated residuals) lead to?  UTIs  Vesicoureteral reflux and hydronephrosis  Kidney damage  Kidney stones  sepsis

 What can we do?!  Urodynamics  Conservative (pelvic floor training, intermittent catheterization)  Pharmacological  Surgical

 Almost double the risk compared to those without DM  Can be 3 different types of incontinence  Urge  Stress  Overflow

 Treatments?  Weight loss and DM control  Conservative (Kegels, etc)  Pharmacological  Surgical

 There is a direct relationship between prostate growth and DM/obesity  How does this work??  …We don’t really know

 Double the risk (in postmenopausal women with DM)  If taking DM meds, triples or quadruples the risk!  Sometimes the kidney also is infected (pyelonephritis) possibly leading to decreased renal function

 Can also lead to renal abscesses or papillary necrosis  Treatments  Prophylaxis or intermittent treatment  DM control  Estrogen  Yogurt, cranberry juice  Low post-void residuals

 Risks factors  DM  Obesity  High blood pressure  Lipid disorders  Smoking  Heart disease

 20-71% of patients with DM have ED  Smoking doubles the risk  The worse the DM, the worse the ED

 Treatments  Meds  Intraurethral pellet  Injections  Penile Pump  Penile Prosthesis

 Low T can be a predictor of upcoming DM!  Testosterone decreases with obesity and age  Testosterone replacement can improve sensitivity to insulin  It has also been shown to actually delay the progression of DM, the metabolic syndrome, ED, and voiding dysfunction

 Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008  In 2008, a total of 202,290 people with end- stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States  20-30% of people with DM will be affected by this

 If creatinine is above 1.5, there’s a linear increase in morbidity and mortality (age is the best independent predictor long term)  Can ultimately lead to end-stage renal failure…which leads to worsening cardiovascular disease  Treatments  Hemodialysis  Peritoneal dialysis  Kidney transplant

 16% of DM patients on HD ultimately undergo renal transplant  Selection criteria  Age < 65  No cardiovascular or cerebrovascular disease  No sepsis  No “life-limiting” comorbidity  On the rise – simultaneous kidney and pancreas transplant

 DM is the most common surgical endocrinopathy  Optimize glucose control (affects postop outcomes)

 Diabetes is our enemy!  Better control means better outcomes and slowing the progression down  Team approach – family physician, support groups, dieticians, etc  “Am I part of the cure or am I part of the disease?” - Coldplay

 American Diabetes Association  “Diabetes and the urologist: a growing problem”, Goldstraw, BJU International, 2006.