Comment on “Diabetes Mellitus and Recurrent Urinary Tract Infections”

The most common bacterial infection in females is urinary tract infection (UTI), and 80% to 90% of UTIs involve the lower urinary tract (bladder and urethra). Recurrent lower UTI is defined as 2 or more acute UTIs within 6 months or 3 or more within 1 year in the absence of structural or functional abnormalities. Individuals with diabetes mellitus (DM) have an increased risk of UTI; though several factors have been determined to affect risk level (severity of hyperglycemia, medications, etc.), evidence-based guidelines on the management of UTIs in DM are limited. This is a clinical consensus statement from the American Urogynecologic Society (AUGS) that aims to review the existing published evidence surrounding epidemiology, risk factors, prevention, and treatment of recurrent UTIs in patients with DM to inform and guide clinical care.

The population of interest for this statement was women aged 18 and above with recurrent UTIs and DM or any definition of cystitis and lower UTIs. Glucose intolerance was included in 3 categories: prediabetes, type 1 DM, and type 2 DM. A literature search was performed for articles published between 1995 and 2024, using PubMed, Embase, Scopus, Biosis, CINAHL, Proquest Central, and Cochrane Library, among others. The exclusion criteria for studies were populations not including women with DM, outcomes unrelated to UTIs, asymptomatic bacteriuria, or glycemic control, focusing on men, pregnancy, pediatrics, animals, or surgical/oncologic populations, duplicate publications, and non–peer-reviewed sources. After identifying 32 manuscripts, 11 questions were developed to guide the consensus statement, and an iterative Delphi survey was conducted. There were 9 final statements included in this document, concerning epidemiology, risk factors, and prevention and treatment.

Based on this review, there is evidence that patients with DM experience a higher prevalence of asymptomatic bacteriuria, UTIs, and recurrent UTIs. The findings are consistent across diverse populations, and the evidence is of high quality. In contrast, evidence surrounding risk factors such as glycemic control, type and duration of DM, and specific antiglycemic medications is inconsistent and limited by study design and/or confounding variables. Additional research is needed to clarify the interaction of these factors and identify interventions for reducing the burden of UTI in this population. The expert panel did agree, however, that based on available evidence, worsening glycemic control is associated with an increased risk of recurrent UTI. Finally, there is no evidence that the management of lower UTI should differ for patients with DM, and preventive measures are effective for both women with DM and those without. Of note, much of the available evidence on prevention is focused on type 2 DM, which may limit the generalizability for type 1 DM.

Future research is needed to assess the impact of specific types of medications and clarify appropriate management for recurrent UTIs in this population. In addition, future studies should attempt to identify underlying mechanisms for the observed increased risk of UTI, asymptomatic bacteriuria, and recurrent UTI in this population.

(Summarized from Dueñas-Garcia OF, Chung DE, Geynisman-Tan J, Ringel NE, Burnett LA, Jeppson PC, Liang R. Diabetes mellitus and recurrent urinary tract infections. Urogynecology 2026;32:477–485. DOI: 10.1097/SPV.0000000000001823).