Recurrent Urinary Tract Infections in Patients with Type 2 Diabetes Mellitus: A Narrative Review

Abstract

Recurrent urinary tract infections (rUTIs) represent a frequent and clinically challenging complication among patients with type 2 diabetes mellitus (T2DM). Impaired glycemic control alters host defense mechanisms, promotes glycosuria, and facilitates bacterial adhesion and colonization within the urinary tract, thereby increasing susceptibility to recurrent infections. This narrative review summarizes current evidence regarding the epidemiology, pathophysiology, microbial characteristics, diagnostic considerations, and management strategies of rUTIs in individuals with T2DM. Escherichia coli remains the predominant uropathogen; however, diabetic patients are disproportionately affected by multidrug-resistant organisms, complicating therapeutic decision-making. Autonomic neuropathy and bladder dysfunction further contribute to urinary stasis and infection recurrence. Diagnosis relies on careful clinical assessment supported by urine microscopy and culture, which is particularly important in diabetic patients to guide appropriate antimicrobial therapy. Management principles are generally similar to those applied in non-diabetic individuals but require classification of most infections as complicated, emphasizing culture-guided antibiotic selection, appropriate treatment duration, and vigilant monitoring. Non-pharmacological measures, strict glycemic control, and evaluation for structural or functional urinary tract abnormalities are essential components of care. Emerging therapies, including sodium–glucose cotransporter-2 inhibitors and non-antibiotic preventive approaches such as probiotics, warrant further investigation. An integrated, multidisciplinary approach combining optimized diabetes management with judicious antimicrobial use is critical to reducing recurrence, preventing complications, and limiting antimicrobial resistance in this vulnerable population.