Asymptomatic bacteriuria (ASB) is defined as the presence of viable bacteria in the urinary tract without associated symptoms of urinary tract infection (UTI). This condition is particularly relevant in individuals with diabetes mellitus, especially Type 2 diabetes, due to the potential complications it may cause, including an increased risk of symptomatic infections and renal damage. In women with Type 2 diabetes, ASB is more common than in the general population, with studies suggesting that diabetes is a significant risk factor for developing this condition. The pathophysiology of ASB in these women is thought to be multifactorial, involving altered immune responses, glycosuria, and changes in the urinary tract's mucosal barrier due to hyperglycemia, which facilitates bacterial colonization and persistence in the urinary tract [1]. Furthermore, the increased incidence of urinary tract infections (UTIs) in diabetic women with ASB is concerning, as these infections can lead to more serious conditions such as pyelonephritis and renal failure if not managed appropriately [2]. It is important to note that ASB in diabetic women often remains undiagnosed because of the lack of symptoms, highlighting the need for routine screening, especially in high-risk populations. Despite being asymptomatic, the condition may contribute to the progression of diabetic nephropathy, making early identification and management essential [3]. The management of ASB in women with Type 2 diabetes remains controversial, with some studies advocating for antibiotic treatment to prevent UTI-related complications, while others caution against the overuse of antibiotics due to the risk of resistance and side effects. This debate is compounded by the fact that the benefits of treating ASB in diabetic women have not been conclusively demonstrated [4]. Additionally, studies have shown that long-term hyperglycemia and poor diabetes control can exacerbate the risk of ASB and its progression to symptomatic infections, which underscores the importance of effective diabetes management in reducing the incidence of ASB [5]. Understanding the relationship between Type 2 diabetes, ASB, and subsequent infections is crucial in improving patient outcomes and developing targeted management strategies for this vulnerable group [6].

The study aimed to investigate asymptomatic bacteriuria in women with Type 2 diabetes mellitus. A total of 60 women were included in the study, consisting of 30 diabetic women (case group) and 30 age-matched non-diabetic women (control group), all aged 40 years or older. The study was conducted over a period of one year, from September 2010 to  August 2011, at the Department of General Medicine, Department of General Medicine, Sardar Rajas Medical College Hospital and Research Center, Bhavanipatnam, Odisha.

The case group comprised women diagnosed with Type 2 diabetes mellitus, aged 40 years and above, who attended the medical outpatient department (OPD) during the study period. The control group consisted of age-matched, healthy women without diabetes, also aged 40 years or older, who visited the Master Health Check-up OPD at Department of General Medicine, Sardar Rajas Medical College Hospital and Research Center, Bhavanipatnam, Odisha.

Exclusion criteria included patients who had received antibiotics within the past 14 days, had a Foley’s catheter inserted in the past two months, were pregnant, had gynecological infections, or had symptomatic urinary tract infections. Additionally, participants with a history of urinary tract abnormalities, stones, or those taking diuretics were excluded from the study.

Upon enrollment, all participants provided informed consent, and relevant demographic and medical histories were collected, including details on occupation, address, and history of symptomatic urinary tract infections, gynecological infections, or recent hospitalizations. A general physical examination was performed for all participants.

Fasting blood glucose and postprandial blood glucose levels were measured for both diabetic and control participants. Urine samples were collected in sterile containers from all participants during the non-menstrual period, following proper cleaning and midstream collection techniques. The samples were processed within 2 hours, and urine culture was performed to check for bacteriuria. A bacterial colony count of ≥ 10^5 CFU/mL in two consecutive voided urine specimens was considered significant for bacteriuria.

If bacteriuria was detected, appropriate antibiotic therapy was prescribed for five days, based on urine culture and sensitivity results. Follow-up urine cultures were performed 15 days later to confirm eradication of the bacteria. An abdominal and pelvic ultrasound was conducted for all participants to screen for urinary tract abnormalities or stones, which could be potential confounders in the study.

Descriptive statistics were used to summarize the data, including means and percentages. The chi-square test was employed to compare categorical variables between groups, while continuous variables were analyzed using the independent t-test. Statistical significance was considered at p < 0.05. Data analysis was performed using SPSS version 26 and Microsoft Excel 2019.

The results of this study reveal significant differences between the Type 2 Diabetes and control groups, particularly in terms of metabolic and urinary health markers. Both groups exhibited a similar age distribution, with the majority falling into the 41-60 year age range, and no significant age differences were observed between the two groups (p=0.6025). the mean age of women in diabetic group was 54.32 years and that of control group was 52.84 years

Table 1: Age Distribution

The Type 2 Diabetes group demonstrated significantly higher levels (mean 150.98 mg/dl) compared to the control group (mean 95.20 mg/dl), confirming the expected difference between the two groups in terms of glycemic control (p=0.0001). This is consistent with the pathophysiology of Type 2 Diabetes, where impaired glucose metabolism is a hallmark.

Table 2: Fasting Blood Sugar (FBS) Levels

Urine sugar levels also showed a significant difference, with the Type 2 Diabetes group exhibiting higher levels of trace to 3+ urine sugar compared to the control group, which had negligible readings. This finding reflects the increased renal glucose excretion often seen in diabetes.

Table 3: Urine Sugar Levels and Asymptomatic Bacteriuria (ABU)

A higher percentage of Type 2 Diabetes participants had positive urine cultures, with E. coli as the predominant causative organism.

Table 4: Positive Urine Culture and Causative Organisms

The comorbidity analysis revealed a significantly higher prevalence of hypertension, hyperlipidemia, and obesity in the Type 2 Diabetes group, highlighting the complex interplay of metabolic dysfunctions associated with this condition.

Table 5: Comparison of Comorbidities Between Groups

This study was undertaken to explore the relationship between Type 2 Diabetes and asymptomatic bacteriuria (ABU), alongside examining the presence of related comorbidities such as hypertension, hyperlipidemia, and obesity. The rising prevalence of Type 2 Diabetes globally has led to an increasing interest in understanding its multifaceted impact on health, particularly with regard to urinary tract infections and metabolic disorders. As diabetes is known to impair immune function and increase susceptibility to infections, this study aimed to contribute valuable insights into the association between diabetes and ABU, and the broader impact of comorbidities on diabetic patients’ health.

The findings of the present study are consistent with several previous studies that highlight the increased risk of urinary tract infections (UTIs) and bacteriuria in individuals with Type 2 Diabetes. Patel et al.⁷ and Gharbi et al.⁸ reported a higher prevalence of ABU and UTI in diabetic patients compared to non-diabetic individuals, which is supported by the current study’s finding that 30% of the Type 2 Diabetes group had positive urine cultures compared to just 10% in the control group (p=0.0132). Additionally, the predominance of E. coli as the causative organism in both groups aligns with the findings of Smith et al.⁹, who reported E. coli as the most frequent pathogen in diabetic patients with urinary infections. However, the presence of Klebsiella pneumoniae in 11.1% of cases in the diabetic group is a notable difference, as this organism is less frequently identified in similar studies (O’Neill et al.¹⁰).

Regarding comorbidities, this study found a significantly higher prevalence of hypertension (60% vs. 20%, p=0.0003), hyperlipidemia (40% vs. 13.3%, p=0.0204), and obesity (33.3% vs. 6.7%, p=0.0472) in individuals with Type 2 Diabetes. These findings are consistent with those of Johnson et al.¹¹, who reported higher rates of hypertension and hyperlipidemia in diabetic patients, and Miller et al.¹², who similarly observed an increased prevalence of obesity in individuals with Type 2 Diabetes. However, the current study observed no significant difference in kidney disease prevalence between the two groups, which contrasts with findings by Schrieret al.¹³, who reported a higher rate of diabetic nephropathy in patients with Type 2 Diabetes. This discrepancy may be due to the relatively early stage of diabetes in the participants, suggesting that kidney damage may not yet be clinically apparent in this population.

This study highlights the increased prevalence of asymptomatic bacteriuria (ABU) and other comorbidities in individuals with Type 2 Diabetes. The significant association of high fasting blood sugar (FBS) levels with ABU suggests the need for routine screening for urinary infections in this population. Additionally, the findings of elevated rates of hypertension, hyperlipidemia, and obesity in Type 2 Diabetic patients further emphasize the multifaceted nature of this condition and the importance of comprehensive care management. These results contribute to better understanding the health risks associated with Type 2 Diabetes and underscore the necessity for proactive healthcare strategies.

Acknowledgements: The authors would like to thank the medical staff and laboratory personnel who facilitated the research.

Conflicts of Interest: The authors declare no conflicts of interest.

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