Urinary autonomic dysfunction and associated factors among patients with type 2 diabetes mellitus in Zanzibar: A cross-sectional study

Abstract

Urinary Autonomic Dysfunction (UAD) is a common complication of Type 2 Diabetes Mellitus (T2DM) that can substantially impair quality of life. It may manifest as loss of bladder control, difficulty initiating or maintaining urination, and incomplete bladder emptying. However, its prevalence and risk factors remain underexplored, particularly in low-resource settings like Zanzibar. This study aimed to determine the prevalence of UAD and its association with pharmacological, clinical, and lifestyle factors among T2DM patients in Zanzibar. A cross-sectional study was conducted among 364 patients with T2DM attending outpatient clinics in Zanzibar. Participants were recruited from local healthcare facilities, and data were collected using structured interviews. UAD symptoms were assessed using the urinary subdomain of the Composite Autonomic Symptom Score-31 (COMPASS-31). Descriptive and inferential statistical analyses were conducted to determine the prevalence and identify factors associated with UAD. The prevalence of urinary autonomic dysfunction (UAD) was 24.5% (89/364). Multivariable logistic regression analysis showed that a history of cigarette smoking was independently associated with higher odds of UAD (AOR = 4.15, 95% CI: 1.73-9.94, p = 0.001). Participants who reported rarely consuming vegetables or consuming only one portion per day had significantly higher odds of UAD than those consuming two or more portions daily (AOR = 3.65, 95% CI: 1.67-7.96, p = 0.001). Use of lipid-lowering medications was also independently associated with higher odds of UAD (AOR = 3.81, 95% CI: 1.83-7.93, p < 0.001). UAD affected nearly one-quarter of patients with type 2 diabetes mellitus in Zanzibar. Cigarette smoking, low vegetable intake, and the use of lipid-lowering medications were significantly associated with increased odds of UAD. These findings support the need for routine assessment of urinary symptoms in patients with T2DM and greater attention to potentially modifiable lifestyle factors. Further longitudinal studies are needed to clarify the temporal and clinical relationship between lipid-lowering medication use and UAD.