Type 2 diabetes mellitus (T2DM) is a known risk factor for recurrent urinary tract infections (rUTIs), which impacts the response to antimicrobial therapy due to glycemic variability. This study aimed to evaluate the association between glycemic control and antimicrobial treatment response in T2DM patients with rUTIs.

A prospective observational comparative cohort study was conducted in the Wasit province of Iraq at Al-Zahraa Teaching Hospital and private internal medicine clinics from October 2024 to June 2025. Patients with rUTIs were enrolled, including patients with T2DM. Patients underwent structured follow-up at Days 1, 3, 7, and 30. Laboratory testing, urine cultures, antibiotic sensitivity tests, and antimicrobial prescriptions were assessed. Outcomes included clinical cure (Day 14) and recurrence (Day 30).

Among the 99 patients who participated, 58 (58.6%) had diabetes, while the remaining 41 (41.4%) were non-diabetic. The most frequently identified bacteria in this study were Escherichia coli (32%), Staphylococcus aureus (20%), Enterococcus species (15%), Pseudomonas aeruginosa (17%), and Proteus spp. (7%). The study results demonstrate a significant association between diabetes status and the age of patients (p-values of <0.001). Furthermore, there was a significant association between UTI recurrence and RBS, the HbA1c variable (p-value=0.001). Patients with poor glycemic control demonstrated substantially higher recurrence rates within 30 days following treatment (65%) compared with patients with good glycemic control (22.2%), whereas no recurrence was observed among non-diabetic patients. Resistance patterns were more prominent in the uncontrolled group. Poor glycemic control was associated with increased UTI recurrence despite adequate initial antimicrobial response, underscoring the importance of glycemic optimization for sustained treatment success.

Plain Language Summary

Urinary tract infections (UTIs) occur more frequently in people with type 2 diabetes and often recur after treatment. This study investigated how blood glucose control and disease severity influence the response to antimicrobial therapy and the likelihood of infection recurrence. A prospective study was conducted among patients with type 2 diabetes who experienced recurrent UTIs. Clinical data, laboratory findings, and antimicrobial susceptibility patterns of the isolated bacteria were evaluated. Patients were categorized according to their glycemic status to assess whether blood sugar control affected treatment outcomes. The results suggest that better glycemic control is associated with improved response to antimicrobial therapy and may reduce the risk of recurrent infections. The study also highlights variations in antimicrobial susceptibility among the bacterial isolates, emphasizing the importance of culture-guided therapy. These findings may help clinicians optimize the management of recurrent UTIs in diabetic patients by considering both glycemic control and appropriate antimicrobial selection.