Investigation of factors playing a role in the development of urinary tract infection in diabetic patients

Introduction and Aim: In this study, it was aimed to determine the frequency of urinary tract infection and risk factors in patients with diabetes mellitus, and to investigate the relationship between insulin and other oral antidiabetic treatments used to provide glycemic control and the development of urinary tract infection. Materials and Methods: This retrospective study included 422 patients older than 18 years of age with diabetes mellitus who applied to the Endocrinology Outpatient Clinic of Dicle University Faculty of Medicine between 01.10.2021 and 30.12.2021. Patient age, gender, HbA1c, C-peptide, white blood cell and neutrophil count, leukocytes in urine, nitrite in urine, glucose in urine, c-reactive protein, sedimentation, procalcitonin, blood glucose, urea-creatinine, alt, ast and albumin values were measured. . Data analysis was performed using the SPSS 26 (Statistical Package Social Science) statistical program. Numerical data with normal distribution were evaluated with Student's T test, and numerical data that did not show normal distribution were evaluated with Mann Whitney U test. Categorical data were evaluated with the Chi-square test. A series of univariate logistic regression analyzes were performed to explain the development of urinary tract infection. Detection of 10 or more leukocytes in uncentrifuged urine was considered as urinary tract infection. Results: It was found that 23.2% of the patients developed urinary tract infection during the follow-up period. It was observed that urinary tract infection developed in 31.4% of women and 10.4% of men. It was observed that urinary tract infection developed at a higher rate in women than in men (p=0.482). When the ages of the patients were examined, the age of the patients who developed urinary tract infection was found to be higher and this difference was statistically significant (p=0.0129). The HbA1c values of the patients who developed urinary tract infection were found to be statistically significantly higher (p=0.002). Blood glucose values were found to be statistically significantly higher in the group with urinary tract infection (p=0.008). Sedimentation values were found to be statistically significantly higher in the group with urinary tract infection (p=0.006). Albumin values were found to be statistically significantly lower in the patient group with urinary tract development (p<0.001). No significant correlation was found between C-peptide, CRP, white blood cell, neutrophil, glucosuria, and creatinine levels and the development of urinary tract infection. When the relationship between the treatments received and urinary tract infection is examined; Urinary tract infection rate was found to be 10.2% in patients who received SGLT-2 inhibitor. Urinary tract infections were found to be lower in patients who received SGLT-2 inhibitors than in patients who did not receive SGLT-2 inhibitors, and this difference was statistically significant (p=0.022). The rate of urinary tract infection was found to be 17.8% in patients receiving DPP-4 inhibitor. Urinary tract infections were found at a lower rate in patients who received DPP-4 inhibitors than in patients who did not receive DPP-4 inhibitors, and this difference was statistically significant (p=0.03). Urinary tract infection rate was 22.6% in patients taking sulfanilurea, and urinary tract infection rate was 26.6% in patients taking insulin. It was determined that insulin, sulfanilurea, metformin, glitazone and GLP-1 analogue treatments did not make a statistically significant difference in terms of urinary tract infection. Conclusion: 1- It was observed that urinary tract infection developed in approximately ¼ of the diabetic patients. 2-Female gender, high HbA1c, advanced age, high blood sugar, high sedimentation, low albumin can be said to be associated with the development of urinary tract infection. 3- It can be said that there is no significant relationship between C-peptide, CRP, white blood cell, neutrophil, glucosuria, creatinine values and the development of urinary tract infection. 4- While no relationship was found between insulin, sulfanilurea, metformin, glitazone and GLP-1 analogue treatments and urinary tract infection, urinary tract infections were seen at a lower rate in patients who took DPP-4 inhibitors. 5- Contrary to popular belief, urinary tract infections were detected at a lower rate in patients taking SGLT-2 inhibitors. It was thought that the reason for this might be the avoidance of starting SGLT-2 inhibitors in patients at high risk of developing urinary tract infection. 6- The most important limiting parameters of our study were that the diagnosis of urinary tract infection could not be supported by urine culture due to the retrospective nature of the study and the small number of patients whose urine cultures were studied. Considering these limiting factors, prospective studies and adding urine culture to larger patient groups may provide a better understanding of the subject. KEYWORDS: Diabetes mellitus, urinary tract infection