Inflammatory and neuroimmune imbalance in diabetic incontinence: Insights from serum biomarker profiling

Background Diabetic urinary incontinence is a multifactorial condition involving neuropathy, oxidative stress, and epithelial dysfunction. Novel biomarkers such as cathelicidin (LL-37), elafin, neutrophil elastase (HNE), vitamin D, and amyloid beta 1–42 (Aβ1–42) may provide insights into its underlying mechanisms. Methods We conducted a prospective observational study including 120 participants: diabetic patients with urinary incontinence (n = 40), non-diabetic patients with urinary incontinence (n = 40), and healthy controls (n = 40). Serum biomarker levels were measured using ELISA, and group differences were analyzed with ANOVA or Kruskal–Wallis tests, followed by Tukey or Dunn’s post hoc tests, as appropriate. Results Cathelicidin levels were significantly reduced in the diabetic incontinence group compared with controls (p = 0.012). HNE concentrations were markedly higher in diabetic patients (p < 0.001). Elafin levels showed a compensatory increase in both incontinence groups (p = 0.043). Vitamin D levels were significantly lower in the diabetic group (p = 0.028), while Aβ1–42 concentrations were also reduced, consistent with neuroinflammatory changes (p = 0.009). Conclusion These findings suggest that LL-37, HNE, elafin, vitamin D, and Aβ1–42 may play contributory roles in the pathophysiology of diabetic urinary incontinence. While promising as potential biomarkers for disease monitoring, these results should be interpreted cautiously and validated in larger, longitudinal studies.