According to the studies studied, the prevalence of urinary tract infections in patients with type 2 diabetes varies in different countries of the world. On average, 10.16% of patients with type 2 diabetes who participated in the study had a urinary tract infection, compared with 33.29% at Nicholas 2017 (conducted in the United States and Germany) and at Hirji 2012 (in the United States, Germany, and Sweden), with a prevalence rate of 2.55%, has the highest and lowest prevalence rates, respectively [29, 34].
People with type 2 diabetes have a higher chance of developing infections than non-diabetics [40, 41].
A person with UTI is considered to have certain microbial pathogens in his or her urinary tract . In people with type 2 diabetes, the main organism that causes urinary tract infections is the E-Coli bacterium [39, 43, and 44]. Bacterial urinary tract infections are clinically distinct. Septic bacteria cause urinary tract infections with obvious symptoms such as increased frequency of urination, dysuria, haematuria, and painful touch of the hyperaemic area, while aseptic bacteria cause urinary tract infection without obvious symptoms . It is said that the prevalence of aseptic bacteria in people with diabetes is three times higher than in normal people . Also, asymptomatic bacterial infections are more common in these people, which does not indicate that their upper urinary tract is not involved. These people have been observed .
In people with type 2 diabetes, several different mechanisms may increase the risk of urinary tract infections, including diabetic nephropathy, autonomic neuropathy, immune system disorders, and glucosuria [9, 47].
Diabetic nephropathy leads to disorders such as protein excretion and severe glucose. Neurological damage associated with high blood sugar levels can adversely affect the ability of the bladder sensation. Sensory bladder sensory disturbances cause urinary retention. Increases urinary tract infections [48–52].
Diabetes reduces blood circulation, so as diabetes lengthens, it weakens the immune system, which is reduced by treating certain cytokines such as IL_6 and other anti-inflammatory cytokines in a diabetic patient. On the other hand, there are abnormal leukocytes. In diabetics and impaired phagocytic function, leukocytes due to high glucose levels in diabetic patients may contribute to the weakening of the immune system of these patients [53–57].
Apart from BMI, UTI is significantly associated with age, sex, recent UTI history and microalbuminuria .
It should be noted that there is a difference of opinion regarding the effect of diabetes duration and blood sugar control on UTI. The study of vismanthan2009 linked the duration of diabetes to UTI, but not to the study of He2018 (28, 36). The relationship between blood sugar control and UTI is also highly controversial. It is effective in UTI, but in Greeling's study, blood sugar control did not affect whether or not UTI was present [58–60].
With increasing age, the risk of developing UTI in both sexes, especially in women, increases. For example, in the Carrondo2020 study, the UTI rate in people aged 18–64 was 9%, compared with 27.5% in people over 85 years old . In all of the articles reviewed, the UTI rate in women was higher than in men, which appears to be related to bladder neurological dysfunction, physiological bladder changes due to aging or shortness of breath and its proximity to the anus among women [24, 27].
A study of Carrondo2020 in Portugal found that 23.6% of women with type 2 diabetes had UTI, compared with only 10.5% of men with type 2 diabetes . A 2011 study in Fu2014 reported a 14% increase in the incidence of UTI in women with type 2 diabetes and 9.1% in non-diabetic women, compared with 5% in men with type 2 diabetes and 2.4% in non-diabetic men.
The association between diabetes, urinary tract infection and gender has been well established . In a 2018 study in China, out of 1,072 women with type 2 diabetes in the study, 341 people were infected and of the 1,783 men with type 2 diabetes in the study, only 68 people had a urinary tract infection (28). In connection with the study of venmans2009, in which the prevalence rate of UTI in men is higher than in women, it is necessary to provide the necessary explanations. In this study, the prevalence rate of recurrent bacterial cystitis in women was 2%, while in men the prevalence of bacterial cystitis and prostatitis was 3%, so this could be a possible cause of the discrepancy .
Therefore, female gender can be considered a risk factor for urinary tract infection. The prevalence of UTI in Stage1 diabetics is higher than in Stage2, because Stage2 diabetics already have blood sugar control [8, 61].
For example: In Carrondo2020 study, the prevalence rate of UTI in diabetic patients was Stage1, 24.4% and in diabetic patients Stage2, was 4.8% .Living geography appears to be associated with urinary tract infections in patients with type 2 diabetes. In an epidemiological study, the prevalence rate was highest in developing countries (24%) and 12.9% and 19.6% in the United States and Europe, respectively .
One of the limitations of this study, which is mainly due to the review of the study, is the following:
1-Not all articles are available
2-It is not the same as the method of measuring the variables studied in all studies
3- Ignoring nutrition and lifestyle in all studies
4- Due to the inconsistency of the study conditions and the volume of the samples, it is not possible to generalize the results of the present study.
5- It is hoped that the present study provides an organized and complete perspective for the development of screening programs, appropriate planning, and health care policies to prevent the increase in the incidence and complications of UTI in people with type 2 diabetes.