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Diabetes and Vascular Disease

SAT-598 - The Interplay of Glycemic Control, Gastroparesis, and Recurrent Emphysematous Cystitis inType 1 Diabetes Mellitus

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Maliha Tahir, Internal Medicine Resident/MBBS: No financial relationships to disclose


Background:
Diabetes mellitus (DM) predisposes patients to severe urinary tract infections (UTIs) through mechanisms including immune dysfunction, hyperglycemia, and diabetic cystopathy. Emphysematous cystitis (EC) is a rare, complicated UTI seen predominantly in patients with diabetes and is characterized by gas within and around the bladder wall. Around 5% of patients with T1DM develop gastroparesis due to neuromuscular dysfunction and hyperglycemia. We present a case of a patient with type 1 diabetes mellitus (T1DM), severe gastroparesis, and recurrent UTIs who developed EC.

Case: A 35-year-old woman with T1DM, gastroparesis, recurrent UTIs, hypertension, dyslipidemia, GERD, and asthma presented with one week of vomiting, lightheadedness, blurred vision, and abdominal pain. Her HbA1c was 8.4% six weeks prior. Hypovolemia improved with IV fluids. Urinalysis was consistent with UTI. CT imaging revealed air within the bladder wall and pelvic vasculature, consistent with EC. Urine culture grew ESBL Klebsiella pneumoniae. Conservative management included Foley catheter placement and antibiotics. A Foley catheter was placed with maximal drainage to reduce the risk of spontaneous bladder perforation for which she was deemed high risk in the setting of complicated EC. She was discharged after six days on an oral antibiotic course. Six months later, she presented with similar symptoms; HbA1c was 9.4% 3 weeks prior. CT imaging again demonstrated EC. Urine culture grew ESBL K. pneumoniae. CT cystogram ruled out colovesicle fistula. Esophagogastroduodenoscopy revealed gastric debris consistent with gastroparesis refractory to prokinetic agents. She was treated with antibiotics and Foley catheter and outpatient endoscopic myotomy was recommended for gastroparesis.

Discussion: Poor glycemic control significantly increases UTI risk. In T1DM, each 1% increase in HbA1c correlates with a 21% rise in UTI frequency. Over 50% of EC cases occur in patients with DM. While conservative management with bladder drainage and targeted antimicrobials is successful in over 90% of EC cases, recurrence despite treatment highlights the critical importance of addressing underlying glycemic control. Continuous bladder drainage helps with the infection resolution and prevention of complications. EC carries up to 7% mortality rate. Gastroparesis creates additional challenges by complicating glycemic control and requires comprehensive management including advanced diabetes technology and consideration of surgical intervention.

Conclusion: Neuromuscular dysfunction and hyperglycemia in the setting of poorly controlled diabetes is the pathophysiological intersection at which gastroparesis and emphysematous cystitis meet. Optimal glycemic control is essential for preventing serious complications of diabetes.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*