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DIABETES AND THE UROLOGIST Arch Enemies!

Dr. Kenneth Thomas, MD Diabetes Support Group Starkville, MS 7/10/12. DIABETES AND THE UROLOGIST Arch Enemies!. Introduction. 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

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DIABETES AND THE UROLOGIST Arch Enemies!

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  1. Dr. Kenneth Thomas, MD Diabetes Support Group Starkville, MS 7/10/12 DIABETES AND THE UROLOGISTArch Enemies!

  2. Introduction • 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!

  3. Introduction • Other Problems • Heart disease • Stroke • Neuropathy • Blindness • High blood pressure • Amputation • Elevated lipid profiles

  4. Introduction • 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

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

  6. Bladder Dysfunction • 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

  7. Bladder Dysfunction • What can diabetic cystopathy (elevated residuals) lead to? • UTIs • Vesicoureteral reflux and hydronephrosis • Kidney damage • Kidney stones • sepsis

  8. Bladder Dysfunction • What can we do?! • Urodynamics • Conservative (pelvic floor training, intermittent catheterization) • Pharmacological • Surgical

  9. Urinary Incontinence • Almost double the risk compared to those without DM • Can be 3 different types of incontinence • Urge • Stress • Overflow

  10. Urinary Incontinence • Treatments? • Weight loss and DM control • Conservative (Kegels, etc) • Pharmacological • Surgical

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

  12. UTIs • 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

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

  14. ED • Risks factors • DM • Obesity • High blood pressure • Lipid disorders • Smoking • Heart disease

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

  16. ED • Treatments • Meds • Intraurethral pellet • Injections • Penile Pump • Penile Prosthesis

  17. Hypogonadism • 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

  18. Diabetic Nephropathy • 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

  19. Diabetic Nephropathy • 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

  20. Renal Transplantation • 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

  21. Surgery • DM is the most common surgical endocrinopathy • Optimize glucose control (affects postop outcomes)

  22. Summary • 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

  23. Questions/Comments

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

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