Urinary incontinence is overlooked but treatable

This issue covers topics including urinary incontinence, the new drug class of SGLT2 inhibitors for diabetes, and more on the principles of diabetes care.

Urinary incontinence is a common and often underaddressed issue in clinical practice, especially among older women. A recent ACP guideline has estimated that about half of middle-aged and postmenopausal women and three-quarters of those age 75 and older experience urinary incontinence in some form. Luckily, as the guideline has outlined, there are many nonsurgical ways to manage this problem. However, many women suffer in silence because they are too embarrassed to mention their incontinence to their doctors or because they believe it is a normal part of aging and no treatments are available. In our story, Kathy Holliman reviews the ACP guideline and talks to experts about the best ways to diagnose and manage this disorder.

Diabetes is of course one of the main problems internists see in their practices, and a session at Kidney Week 2014, held in November in Philadelphia, offered information on a group of newly approved drugs called SGLT2 inhibitors that lower blood glucose by acting on the kidneys. Experts explained how the drugs work in this capacity as well as some of their other effects, such as weight loss and decreases in blood pressure. Adverse effects were covered as well, including volume depletion, hyperkalemia, genital mycotic infections and urinary tract infections, polyuria, hypoglycemia, and interactions with other drugs. In addition, the experts said, the drugs' effects on cardiovascular health and their impact on the kidneys over the long term are still undetermined. Our coverage explains more.

In other diabetes news, the National Diabetes Education Program (NDEP) recently released its “Guiding Principles for the Care of People With or at Risk for Diabetes,” a collaborative effort involving the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health and several other major organizations. Each of the 10 principles takes a broad topic and offers clinicians specific underlying advice for different populations, such as older adults and women of childbearing age. In a Q&A, Stacey Butterfield talks to Judith Fradkin, MD, director of the Division of Diabetes, Endocrinology and Metabolic Diseases at the NIDDK, about what motivated the development of the principles and how physicians should think about using them.

Also in this issue, our Practice Rx column debates the potential pros and cons of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), including its more detailed codes and levels of specificity, and our Practice Tips column discusses what's needed to obtain patient consent for chronic care management.

What are your opinions about ICD-10? Let us know.


Jennifer Kearney-Strouse