European Journal of Cardiovascular Medicine

Benign Prostatic Hyperplasia (BPH) is a common condition in aging men, characterized by the non-malignant enlargement of the prostate gland¹, which leads to lower urinary tract symptoms (LUTS) such as frequency, urgency, and nocturia. As men age, the prevalence and severity of BPH increase, making it a significant concern in geriatric urology². The pathophysiology of BPH is multifactorial, involving hormonal changes, growth factors, and genetic predispositions. However, the role of systemic diseases such as Diabetes Mellitus (DM) in the development and progression of BPH remains an area of active investigation³.

Diabetes Mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to either insulin resistance or insufficient insulin secretion. Diabetes is known to contribute to a variety of complications, including cardiovascular diseases, nephropathy, and neuropathy⁴. Recent studies suggest that diabetes may also influence the development and progression of BPH, although the exact mechanisms remain unclear. Elevated insulin levels, insulin resistance, and chronic inflammation are thought to play a role in the pathogenesis of BPH, potentially accelerating prostate growth and exacerbating symptoms⁵.

Several studies have proposed a link between DM and an increased risk of BPH, but findings have been inconsistent⁶. Some studies have shown that diabetic men are more likely to develop BPH, while others suggest that the severity and progression of symptoms may be more pronounced in this group. Given the increasing prevalence of diabetes globally and the growing aging population, understanding the relationship between diabetes and BPH is crucial for improving early detection and management strategies⁷.

This study aims to assess the impact of diabetes on the development and progression of BPH, focusing on prostate volume changes and symptom severity in a cohort of male patients. Through this research, we seek to provide insights into the interplay between DM and BPH, thereby contributing to better clinical outcomes for diabetic patients.

Study Design:
This was a prospective observational cohort study conducted at the Government Medical College and General Hospital, Ananthapuramu, from April 2024 to June 2024. The study aimed to assess the impact of Diabetes Mellitus (DM) on the development and progression of Benign Prostatic Hyperplasia (BPH) in male patients.

Study Participants:
A total of 100 male participants were included in the study. Participants were divided into two groups:

Diabetic group: 50 male patients diagnosed with Diabetes Mellitus based on current diagnostic criteria.

Non-Diabetic group: 50 male patients without any history of diabetes or current evidence of impaired glucose metabolism.

Participants were selected based on the following inclusion criteria:

Age between 50 to 80 years.

No history of prostate cancer or other significant urological conditions.

No history of acute or chronic urinary tract infections.

No use of medications that could affect prostate size or function (e.g., 5-alpha reductase inhibitors or alpha-blockers).

Exclusion criteria included patients with:

Prior history of prostate surgery.

Severe renal or liver dysfunction.

Inability to provide informed consent.

Data Collection:
Baseline clinical data were collected, including age, BMI (Body Mass Index), and history of smoking, alcohol consumption, and physical activity. The Glycemic control of diabetic patients was assessed by measuring serum glucose and HbA1c levels.

Outcome Measures:

Prostate Volume: Prostate volume was measured using transrectal ultrasonography (TRUS) at baseline and at the end of the 12-month follow-up period.

International Prostate Symptom Score (IPSS): IPSS was recorded at baseline and at the 12-month follow-up. This score helps assess the severity of urinary symptoms related to BPH.

Incidence of BPH-related Complications: Incidence of acute urinary retention, the need for medical interventions (e.g., catheterization, medication adjustment), and any complications related to BPH progression were also monitored.

Statistical Analysis:
The data were analyzed using SPSS software. Descriptive statistics were used to summarize demographic data, while chi-square tests were used to compare categorical variables. For continuous variables, Student’s t-test or Mann-Whitney U test were used as appropriate. Multivariate logistic regression was performed to identify independent risk factors for BPH development, and hazard ratio (HR) was used to assess the rate of progression.

A p-value of <0.05 was considered statistically significant for all tests.

Ethical Considerations:
Ethical approval for the study was obtained from the Institutional ethics committee of Government Medical College, Ananthapuramu. Written informed consent was obtained from all participants before enrollment in the study.

A total of 100 male participants were included in the study, with 50 diagnosed with Diabetes Mellitus (DM) and 50 in the control group without diabetes. The mean age of participants was 65.4 ± 7.2 years, with no significant difference between the two groups (p > 0.05). Demographic characteristics such as Body Mass Index (BMI) were comparable between the groups (Table 1).

Table 1: Demographics and Clinical Characteristics

Demographics and Clinical Characteristics

The Diabetic group had significantly higher levels of serum glucose and HbA1c compared to the Non-Diabetic group, confirming the presence of poorly controlled diabetes in this cohort (p < 0.001 for both) (Table 1).

Incidence of BPH

The prevalence of Benign Prostatic Hyperplasia (BPH) in the Diabetic group was 72%, whereas in the Non-Diabetic control group, it was 52%. This difference was statistically significant (p = 0.04), suggesting that diabetes may increase the likelihood of developing BPH (Table 2).

Table 2: BPH Prevalence

Progression of BPH

Among those diagnosed with BPH, the Diabetic group exhibited a significantly faster progression of prostate enlargement compared to the Non-Diabetic group. On average, the Diabetic group showed an increase in prostate volume of 1.4 ± 0.8 cm³ over a 12-month period, whereas the Non-Diabetic group showed a smaller increase of 0.9 ± 0.6 cm³ (p = 0.02) (Table 3).

Table 3: Prostate Volume Progression

Additionally, the International Prostate Symptom Score (IPSS) for the Diabetic group worsened significantly during the study period, with an average increase of 5.2 points (p = 0.03). In contrast, the Non-Diabetic group showed a smaller increase of 3.1 points, which was not statistically significant (p = 0.10) (Table 4).

Table 4: IPSS Progression

Multivariate Analysis

Multivariate logistic regression analysis identified diabetes mellitus and age as independent factors associated with the increased risk of developing BPH. Specifically, diabetes mellitus was found to be associated with an odds ratio (OR) of 2.7 (95% CI: 1.4–5.3, p = 0.01) for the development of BPH, while age had an OR of 1.5 (95% CI: 1.1–2.0, p = 0.03), indicating that both factors independently contributed to BPH risk (Table 5).

Table 5: Multivariate Analysis for BPH Development

Furthermore, diabetes was significantly associated with faster progression of BPH, with a hazard ratio (HR) of 1.9 (95% CI: 1.2–3.0, p = 0.01) for the rate of prostate enlargement.

Adverse Outcomes

The incidence of acute urinary retention, a complication associated with BPH, was higher in the Diabetic group (14%) compared to the Non-Diabetic group (6%), though the difference was not statistically significant (p = 0.08) (Table 6). However, the Diabetic group required more frequent medical interventions (e.g., medication adjustments, catheterization) compared to the control group, highlighting the potential impact of diabetes on the management of BPH (Table 6).

Table 6: Adverse Outcomes

This study aimed to assess the impact of Diabetes Mellitus (DM) on the development and progression of Benign Prostatic Hyperplasia (BPH) in male patients. Our findings indicate that DM significantly increases the prevalence of BPH and accelerates its progression. These results align with previous studies that suggest a potential link between DM and prostate enlargement, as well as a more rapid progression of BPH symptoms in diabetic patients.

Prevalence of BPH in Diabetic vs. Non-Diabetic Groups

The prevalence of BPH in the Diabetic group was 72%, compared to 52% in the Non-Diabetic group, which was statistically significant (p = 0.04). These findings support the hypothesis that Diabetes Mellitus may be a contributing factor to the higher risk of BPH. Several mechanisms have been proposed to explain this relationship, including the role of insulin and insulin-like growth factors, which are implicated in the pathogenesis of both DM and prostate enlargement. Insulin resistance and hyperinsulinemia, common features of DM, may contribute to prostate cell proliferation, thereby increasing the risk of BPH development. Moreover, chronic inflammation associated with diabetes could exacerbate prostatic growth^8,9.

Progression of BPH

Our study demonstrated that diabetic patients with BPH had a faster progression of prostate enlargement compared to the non-diabetic group. The prostate volume increased by 1.4 cm³ in the Diabetic group, compared to an increase of 0.9 cm³ in the Non-Diabetic group (p = 0.02). This accelerated progression may be attributed to the chronic metabolic disturbances in DM, including elevated blood glucose and insulin resistance, which could promote prostate cell growth and impair the normal aging process of the prostate gland¹⁰.

Additionally, the IPSS for the Diabetic group worsened significantly over the study period (increase of 5.2 points, p = 0.03), compared to a smaller increase of 3.1 points in the Non-Diabetic group (p = 0.10). This indicates that diabetic men not only experience increased prostate volume but also more severe urinary symptoms, which may impact their quality of life¹¹.

Multivariate Analysis

Multivariate regression analysis revealed that Diabetes Mellitus (OR = 2.7, p = 0.01) and age (OR = 1.5, p = 0.03) were independently associated with a higher risk of developing BPH. These findings are consistent with the literature, which has identified age and diabetes as important risk factors for BPH. In addition, diabetes was found to be a significant factor for faster progression of BPH (HR = 1.9, p = 0.01), highlighting the need for early diagnosis and proactive management of BPH in diabetic patients¹².

Adverse Outcomes

The incidence of acute urinary retention, a complication associated with BPH, was higher in the Diabetic group (14%) compared to the Non-Diabetic group (6%, p = 0.08). Although this difference was not statistically significant, it suggests that diabetes may increase the risk of more severe BPH-related complications¹³. Furthermore, the Diabetic group required more frequent medical interventions, such as medication adjustments and catheterization, indicating that the management of BPH in diabetic patients is more complex and may require closer monitoring and tailored treatment strategies¹⁴.

Limitations

One limitation of this study is its relatively short follow-up period of 12 months. While the study provides valuable insights into the relationship between DM and BPH progression, longer follow-up periods would be necessary to fully assess the long-term impact of diabetes on BPH. Additionally, the study was conducted at a single center, which may limit the generalizability of the findings to other populations.

This study suggests that Diabetes Mellitus significantly increases the prevalence and accelerates the progression of Benign Prostatic Hyperplasia in men. The findings highlight the importance of monitoring diabetic patients for early signs of BPH and considering more proactive management strategies to prevent complications. Further research, including larger-scale multicenter studies with longer follow-up periods, is needed to fully understand the underlying mechanisms and to develop tailored treatment approaches for diabetic patients with BPH.

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