Diabetes and benign prostate hyperplasia in Olmsted County, Minnesota

Purpose The incidence of diabetes (DM) has increased rapidly. Recent studies have shown an association between DM and benign prostate hyperplasia (BPH). These studies, however, have been limited by cross-sectional data without long-term follow-up and lacked population-based samples. We examined the association of DM and BPH in a prospective population-based sample of residents of Olmsted County, Minnesota, with serial surrogate measures of BPH. Methods A cohort of 2115 Caucasian men aged 40 to 79 years was randomly selected from an enumeration of the 1990 Olmsted County, Minnesota, population (55% participation rate). Participants completed a previously validated baseline questionnaire that assessed lower urinary tract symptom severity with questions similar to the AUA Symptom Index (AUASI); a composite AUASI was estimated. The questionnaire also asked whether they had ever been diagnosed by a physician as having DM. Participants voided into a portable urometer to measure peak urinary flow rates (Qmax). A 25% random subsample underwent transrectal sonographic imaging to determine prostate volume (PVOL). Dynamic follow-up was performed biennially for about 10 years and supplemented with the review of community medical records for documented occurrence of acute urinary retention (AUR). A two-stage slope was calculated for AUASI and Qmax. Results A total of 111 (4.6%) of the men had DM at baseline. The mean age was 63.0 (SD = 10.8) and 54.2 (SD = 10.5) years in those with and without DM. Mean body mass index at baseline was 29.3 (SD = 5.4) and 27.0 (SD = 4.0) in those with and without DM. Individuals with DM had significantly greater mean percentage change in AUASI (0.42 vs. 0.16; P = 0.03) and Qmax (4.6% vs. 2.2%; P = 0.04) compared with those without DM; however, there was no difference in change in PVOL or in occurrence of AUR. Conclusion Compared with men without DM, individuals with DM at baseline had significantly greater progression of BPH, as measured by surrogate markers AUASI and Qmax, but not PVOL or AUR, during follow-up. Study results suggest that the presence of DM may be more closely associated with the dynamic components of lower urinary tract function than with BPH.