PracticeUpdate
Urinary Incontinence Responds to Intensive Lifestyle Intervention
Research · July 01, 2014

TAKE-HOME MESSAGE

• This study is a secondary data analysis of the Look AHEAD study, comparing intensive lifestyle intervention with diabetes education and counseling in men with type 2 diabetes. In the intensive lifestyle intervention group, the prevalence of incontinence decreased from 11.3% to 9.0% after 1 year of intervention, while in the diabetes education and counseling group, the prevalence increased from 9.7% to 11.6%. The likelihood of resolution of urinary incontinence was significantly improved in the intensive lifestyle intervention cohort.
• Intensive lifestyle intervention may reduce urinary incontinence in obese diabetic men.

– Matthew Resnick, MD

ABSTRACT

PURPOSE

We determined the effect of an intensive lifestyle intervention on the prevalence, incidence and resolution of bothersome nocturia, increased daytime urinary voiding and urinary incontinence in overweight/obese men with type 2 diabetes after 1 year in the Look AHEAD trial.

MATERIALS AND METHODS

A subset of male Look AHEAD participants was selected for this secondary data analysis. Overall 1,910 men with an average (mean ± SD) age of 59.9 ± 6.7 years and body mass index of 35.2 ± 5.5 kg/m(2) were randomized to an intensive lifestyle intervention or diabetes support and education group. All participants self-reported information regarding incontinence, nocturia and daytime urinary voiding at entry and 1 year.

RESULTS

After 1 year the intensive lifestyle intervention group lost significantly more weight than the diabetes support and education group (9.4% ± 7.0% vs 0.7% ± 4.5%, respectively; p <0.001). The odds of prevalent urinary incontinence at 1 year were reduced by 38% in the intensive lifestyle intervention group compared to the diabetes support and education group. The prevalence of urinary incontinence decreased from 11.3% to 9.0% in the intensive lifestyle intervention group and increased from 9.7% to 11.6% in the diabetes support and education group. The intensive lifestyle intervention group also had increased odds of urinary incontinence resolving (OR 1.93, 95% CI 1.04-3.59, p = 0.04 and 56.0% vs 40.7%, p = 0.03) and trend toward reduced odds of new onset, incident urinary incontinence (OR 0.66, 95% CI 0.42-1.02, p = 0.06) compared with the diabetes support and education arm. In contrast, no differences between intensive lifestyle intervention and diabetes support and education were seen at 1 year for frequency of nocturia or frequency of daytime voiding.

CONCLUSIONS

Intensive lifestyle intervention should be considered for the treatment of urinary incontinence in overweight/obese men with type 2 diabetes.

The Journal of Urology
Intensive Lifestyle Intervention Reduces Urinary Incontinence in Overweight/Obese Men With Type 2 Diabetes: Results From the Look AHEAD Trial

J Urol 2014 Jul 01;192(1)144–149, BN Breyer, S Phelan, PE Hogan, RC Rosen, AE Kitabchi, RR Wing, JS Brown

PubMed Reference
Journal Reference

Intense Lifestyle Intervention Group

The ILI was designed to produce an average of 7% or greater weight loss at 1 year.12 During the first 6 months of the program the participants attended weekly meetings and were then seen 3 times per month for the following 6 months. The ILI included individual and group sessions.12 Calorie restriction was the primary action used to achieve weight loss. Participants were given calorie goals of 1,200 to 1,500 if they weighed less than 250 lb and 1,500 to 1,800 if they weighed more than 250 lb, with a maximum of 30% of calories from fat. ILI participants were instructed to consume a portion controlled low fat and low calorie diet that was supplemented with liquid and frozen meal replacements. Participants were encouraged to gradually increase exercise to 175 minutes per week using moderate intensity activities such as brisk walking.