Type 2 diabetes mellitus (T2DM) is linked to an increased risk of urinary tract infections and to asymptomatic urinary abnormalities such as asymptomatic bacteriuria and asymptomatic pyuria (ASP). ASP in this study is defined as an elevated urinary leukocyte count in the absence of urinary symptoms. The association between ASP and measures of glycemic control has been uncertain. The investigators aimed to determine the prevalence of ASP among patients with T2DM attending a tertiary endocrinology outpatient service and to evaluate relationships between ASP, glycemic parameters, and other urinary findings.
This was a retrospective cross-sectional analysis of consecutive T2DM patients seen at a tertiary care endocrinology outpatient department between June 2018 and May 2020. The cohort comprised 2,843 patients. Data extracted for analysis included urine microscopy findings and routine glycemic measures: fasting plasma glucose, postprandial plasma glucose (PPG), and glycated hemoglobin (HbA1c).
Asymptomatic pyuria (ASP) was operationally defined by the authors as more than 10 leukocytes per high-power field on urine microscopy. The study also recorded presence of nitrituria, proteinuria, and glucosuria on urinalysis. Where available, urine culture results were reviewed to determine rates of bacterial growth and organism distribution. The abstract provides the key methods and definitions used; further methodological details beyond those reported in the abstract were not provided in the PubMed summary.
Among 2,843 patients with T2DM, the prevalence of ASP was 14.98%. Prevalence differed markedly by sex: 30.7% of female patients had ASP compared with 6.87% of male patients (P < 0.0001). The authors also report that patients with ASP were older than those without ASP, although the abstract does not present the exact age distributions or mean ages in each group.
Patients who had ASP demonstrated poorer glycemic indices compared with those without ASP. Specifically, postprandial plasma glucose (PPG) and glycated hemoglobin (HbA1c) values were significantly higher in the ASP group. The abstract does not give exact mean or median glucose or HbA1c values, but emphasizes a statistically significant association.
In addition to leukocyturia, several urinalysis abnormalities were more frequent among patients with ASP: nitrituria, proteinuria, and glucosuria. The presence of nitrites suggests bacterial nitrate-reducing organisms in some cases, while proteinuria and glucosuria may reflect concurrent renal or metabolic abnormalities common in T2DM. The precise frequencies for each abnormality in ASP versus non-ASP groups are not presented in the abstract.
Urine culture results were available for a subset of 84 patients. Of these, 61.9% demonstrated significant bacterial growth. Among culture-positive isolates, Gram-negative organisms predominated. Escherichia coli was the most commonly isolated organism, representing 69.2% of isolates in the cultured subset.
The authors note that a notable proportion of isolates exhibited multidrug resistance. The abstract does not specify the exact antimicrobial agents tested, resistance rates, or definitions used for multidrug resistance, so those details were not reported in the PubMed summary.
In this large outpatient T2DM cohort, ASP was present in roughly 15% of patients and showed clear sex disparity, being substantially more common in women. ASP correlated with older age, higher PPG and HbA1c, and with coexisting urinalysis abnormalities such as nitrituria, proteinuria, and glucosuria. Among the small subset with culture data, more than three in five had bacterial growth and E. coli predominated; a meaningful share of isolates showed multidrug resistance.
The authors conclude that ASP is relatively common in patients with T2DM and is associated with poorer glycemic control and urinary abnormalities. Given the proportion of positive cultures and the reported antimicrobial resistance, they recommend further studies to determine the clinical significance of ASP in T2DM and to guide management strategies. The abstract does not provide specific clinical management recommendations or details on outcomes related to ASP, and the study's limitations beyond the retrospective design are not elaborated in the abstract.