{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:38:19Z","timestamp":1785541099561,"version":"3.56.0"},"reference-count":38,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K01AG073532"],"award-info":[{"award-number":["K01AG073532"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K24AG066998"],"award-info":[{"award-number":["K24AG066998"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K76AG059986"],"award-info":[{"award-number":["K76AG059986"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K23AI166030"],"award-info":[{"award-number":["K23AI166030"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2025,7,12]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended as first-line cardiorenal protective therapy in type 2 diabetes. Because SGLT2is cause glycosuria and increase urine volume, they may exacerbate incontinence symptoms among patients with pre-existing urinary incontinence. Our objective was to determine how many adults meeting guideline indications for SGLT2i have frequent urinary incontinence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>We conducted a cross-sectional analysis of National Health And Nutrition Examination Survey (NHANES) participants aged \u226555 with type 2 diabetes in 2013\u20132020. We determined whether participants met American Diabetes Association guideline indications for an SGLT2i due to heart failure or chronic kidney disease, or due to atherosclerotic cardiovascular disease or high cardiovascular risk (for the latter two cardiovascular indications, GLP-1RAs are guideline-recommended alternative medications). Frequent urinary incontinence was defined by self-report of leaking urine daily\/nightly or a few times per week.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 1726 NHANES participants aged \u226555 with type 2 diabetes, representing 16.0 million US adults; 19.6% (95% CI 17.3% to 22.2%) (3.1 million) met indications for an SGLT2i specifically and 50.9% (95% CI 47.2% to 54.7%) (8.2 million) met indications for either an SGLT2i or a GLP-1RA. Among those with indications for an SGLT2i specifically, 32.4% (95% CI 25.9% to 39.8%) had frequent urinary incontinence, representing 333\u2009000 men and 685\u2009000 women. Among those with indications for either an SGLT2i or GLP-1RA, 25.5% (95% CI 20.8% to 30.8%) had frequent urinary incontinence, representing 630\u2009000 men and 1413 000 women.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Frequent urinary incontinence affects &gt;15% of men and &gt;40% of women aged \u226555 years with guideline indications for SGLT2i. Studies are needed to determine if incontinence increases risk of genital infections when initiating SGLT2is.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2025-004929","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T07:45:17Z","timestamp":1754034317000},"page":"e004929","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Urinary incontinence in US adults aged \u226555 years with type 2 diabetes and indications for SGLT2is: NHANES 2013\u20132020"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9525-3833","authenticated-orcid":false,"given":"Alexandra K","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasia J","family":"Lipska","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn E","family":"Callahan","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine, Winston-Salem, Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Raphael","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sei J","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA"},{"name":"San Francisco VA Medical Center, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"2025080100451330000_13.4.e004929.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2021.101163","article-title":"Net effects of sodium-glucose co-transporter-2 inhibition in different patient groups: a meta-analysis of large placebo-controlled randomized trials","volume":"41","author":"Staplin","year":"2021","journal-title":"EClinicalMedicine"},{"key":"2025080100451330000_13.4.e004929.2","doi-asserted-by":"crossref","first-page":"2310","DOI":"10.1111\/dom.15111","article-title":"Sodium-glucose cotransporter-2 inhibitors and kidney outcomes in real-world type 2 diabetes populations: A systematic review and meta-analysis of observational studies","volume":"25","author":"Forbes","year":"2023","journal-title":"Diabetes Obes Metab"},{"key":"2025080100451330000_13.4.e004929.3","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1111\/dom.14893","article-title":"Sodium-glucose co-transporter-2 inhibitors in type 2 diabetes: Are clinical trial benefits for heart failure reflected in real-world clinical practice? A systematic review and meta-analysis of observational studies","volume":"25","author":"Hinton","year":"2023","journal-title":"Diabetes Obes Metab"},{"key":"2025080100451330000_13.4.e004929.4","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.2337\/dc23-0671","article-title":"Comparative Cardiovascular Effectiveness and Safety of SGLT-2 Inhibitors, GLP-1 Receptor Agonists, and DPP-4 Inhibitors According to Frailty in Type 2 Diabetes","volume":"46","author":"Kutz","year":"2023","journal-title":"Diabetes Care"},{"key":"2025080100451330000_13.4.e004929.5","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S009"},{"key":"2025080100451330000_13.4.e004929.6","unstructured":"Department of Veterans Affairs, Department of Defense . VA\/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus, 2023. 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NHANES Questionnaires, Datasets, and Related Documentation. National Health and Nutrition Examination Survey, Available: https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/Default.aspx [Accessed 4 Jun 2025]."},{"key":"2025080100451330000_13.4.e004929.17","unstructured":"NHANES . 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