We screened 228 women with diabetes for bacteriuria during the period of January 1997 through December 2000 at Pisa General Hospital (Pisa, Italy). A control group of 146 women without diabetes was also evaluated. The frequency of significant bacteriuria was 17.5% (40 of 228) among women with diabetes and 18.5% (27 of 146) among women in the control group. Seven (13.5%) of 52 and 33 (18.8%) of 176 women with type 1 and in type 2 diabetes, respectively, had significant bacteriuria. The presence

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... f higher glycated hemoglobin levels was the only significant risk factor for significant bacteriuria in women with type 2 diabetes. A similar frequency of bacteriuria in women with and women without diabetes was found. Severe impairment of metabolic control of type 2 diabetes increases the risk of acquiring asymptomatic bacteriuria. Urinary tract infection (UTI) is classically assumed to be a clinically relevant problem for patients with diabetes [1]. Severe complications of UTI occur virtually only in patients with diabetes. In 1935, Sharkey and Root [2] reported purulent UTI in 18% of the necroscopy specimens obtained from patients with diabetes. Robbins and Tucker [3] reported that, at autopsy, 4.5% of patients with diabetes had papillary necrosis. Some individuals with diabetes may present with a distressing picture showing definite progression of pyelonephritis characterized by evidence of systemic infection, local extension of the infection (e.g., renal and perinephric abscesses), septicemia, and severe impairment of metabolic control, which may become too difficult to manage. For these reasons, diabetes has long been considered to be a predisposing factor for UTI. However, since the concept of significant bacteriuria was introduced, the reported data on the prevalence of asymptomatic bacteriuria (ASB) among patients with diabetes appear to be conflicting [4] [5] [6] [7] [8] . Many UTIs are asymptomatic, especially in women. Unlike men with or without diabetes (among whom similar rates of UTI have been documented in most studies), several recent reports have noted a higher prevalence of ASB among women with diabetes than among women without diabetes [8] [9] [10] [11] . Early studies, however, showed no difference between the frequency of both asymptomatic and symptomatic bacteriuria among women with diabetes, compared with women in matched control groups [12] [13] [14] [15] . Various risk factors for ASB in women with diabetes have been suggested (e.g., age, sexual intercourse, disease duration, quality of metabolic control of disease, and status of diabetic complications [16] [17] [18] [19] [20] ). Most reports, however, included only a small number of patients, often without distinguishing between those with type 1 and those with type 2 diabetes. Consequently, we decided to investigate the frequency of ASB in a large study involving women with diabetes. In addition, all women with diabetes were evaluated to verify whether there is a correlation between bacteriuria and the following suggested risk factors: the known duration of diabetes, the actual metabolic control of diabetes, morphological and functional aspects of the kidneys, Downloaded from https://academic.oup.com