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ABSTRACT Importance Urinary incontinence (UI) is a common condition among women and significantly impairs quality of life (QOL). Both obesity and abnormal glucose metabolism have been associated with lower urinary tract symptoms; however, their relative contributions to symptom severity remain unclear. Objectives To evaluate the association between body mass index (BMI) and UI severity in women with abnormal glycemic status, specifically prediabetes and diabetes. Study Design This retrospective cohort study included 192 women with UI presenting to a tertiary urogynecology clinic between 2011 and 2022. Participants were categorized according to hemoglobin A1c (HbA1c) levels as prediabetic (5.7–6.4%) or diabetic (≥6.5%) and further stratified by BMI into non-obese (BMI <30 kg/m 2 ) and obese (BMI ≥30 kg/m 2 ) groups. Urinary symptoms and quality of life were assessed using validated instruments including the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7), the Overactive Bladder Awareness Tool (OAB-v8), and the Sandvik Incontinence Severity Index. Multivariable analyses were performed to evaluate associations while adjusting for potential confounders. Results Of the cohort, 63 (32.8%) were prediabetic and 129 (67.2%) were diabetic. Baseline characteristics were similar between glycemic groups. Within the prediabetic group, obese women had higher OAB-v8 scores compared with non-obese women (28.5 ± 8.7 vs 16.7 ± 8.9, p < 0.001). Among diabetic women, obese participants had higher UDI-6 stress subscale scores (60.9 ± 31.0 vs 40.2 ± 34.3, p = 0.005) and a higher frequency of positive cough stress tests (61.2% vs 36.4%, p = 0.019). In multivariable analysis adjusting for parity, obesity remained associated with higher IIQ-7 scores (β = 7.8; 95% CI: 0.7–14.9; p = 0.032), while associations with stress incontinence measures were attenuated. Conclusions Higher BMI was associated with greater urinary symptom severity and worse condition-specific quality of life among women with dysglycemia. However, these associations were influenced by parity, and the absence of a normoglycemic control group limits causal interpretation. Prospective studies including normoglycemic controls are needed to better define the relative contributions of BMI and glycemic status to urinary incontinence severity.
Çetindağ et al. (Wed,) studied this question.