A rising number of people around the world are living with diabetes mellitus (DM), a type of non-communicable disease. Throughout their diabetes, diabetic neuropathy develops in at least 50% of people. Diabetic complications have increased in both developed and developing nations during the last several decades. In the last several decades, the incidence of diabetes has skyrocketed around the globe. Between the ages of 20 and 79, an estimated 537 million persons around the world are impacted by diabetes. The number of persons with diabetes will rise from 643 million in 2030 to 783 million in 2045. (1)

Diabetic neuropathy (DN) is a clinical entity that encompasses a range of neuropathic illnesses. Its clinical symptoms include peripheral neuropathy and other types of autonomic dysfunction, such as gastrointestinal, urogenital, and cardiovascular disorders. With an estimated lifetime frequency of over 50%, it continues to be a very prevalent consequence of diabetes despite advancements in clinical management (2). Globally, 783 million adults are expected to have diabetes by 2045, with up to 350 million more likely to develop the disease and its complications. A lower quality of life can result from intense pain, loss of feeling, decreased balance, falls, ulceration, and amputations in people with diabetic peripheral neuropathy (DPN)(3). Because it can worsen cardiovascular illness and increase the risk of heart failure and sudden cardiac death, cardiovascular autonomic neuropathy (CAN) is a feared consequence. DPN alone is responsible for more than one-fourth of the total direct medical costs associated with diabetes and more than $10 billion in annual healthcare expenses (4,5).

Peripheral neuropathy has numerous potential causes, but the most common form, diabetic peripheral neuropathy (DPN), can cause serious problems that might range from paraesthesia to limb loss and even death. To prevent neuropathic foot ulcers and the associated morbidity and mortality from the pathophysiologic poor wound healing potential—which can result in limb compromise, local to systemic infection, septicemia, and even death—early evaluation of peripheral polyneuropathy symptoms is essential (6). Large fibre sensation with vibrations, ulceration risk with pressure testing with a 10 g monofilament, and small fibre sensibility with temperature changes or pinpricks are the main neurological evaluations used in clinical diagnosis of DPN. Only patients exhibiting aberrant clinical signs (such as the rapid onset of symptoms, significant neuromotor dysfunction, and asymmetrically altered feeling) should have neurology consultation and specialized testing, such as nerve conduction studies and intraepidermal nerve fiber density testing (7).

DPN's precise cause is unknown. Autoimmune, neurovascular, and metabolic pathways are among the hypotheses that have been put forth. Genetics, chronic alcohol use, smoking, and social and lifestyle variables have all been linked to mechanical compression (e.g., carpal tunnel). Insulin resistance is brought on by persistently elevated blood serum glucose, which encourages oxidative stress, inflammation, and cell damage (8). Damage to the distal sensory and autonomic nerve fibers occurs first, and as the damage progresses proximally, the epidermis and foot joints gradually lose their protective sense (9). DPN management involves several tactics, such as glucose control, dietary changes, weight loss, pain management, and preventative efforts (e.g., patient education, adequate foot care, appropriate shoe wear, and annual foot exam) (10,11). Half of diabetic peripheral neuropathies may be asymmetrical. Patients are more likely to have an injury if their insensate feet are not identified and preventative foot care is not practiced (12-14).

The purpose of this study was to ascertain the prevalence of diabetic peripheral neuropathy and its risk variables.

A cross-sectional study was carried out in 184 patients who are attending Prathima Relief Institute of Medical Sciences in Arepally, Warangal from 2022 to 2023. Patients who had already been diagnosed with Type 1 or type 2 DM and coming for a follow-up visit. Informed consent was taken from all participants before enrolling into the study.

Sample size Calculation: Sample size was calculated using the formula (15)

N = 4 PQ/L2 х design effect

Where P = Prevalence of diabetic peripheral neuropathy 

 Q = 100 – P

 L is allowable error = 5 with design effect of 2.

Sampling technique: 

Convenience sample technique was used in this study, which carried out on patients over 30 years old who had already been diagnosed with either T1DM or T2DM who were available at the time of the study and fulfilled the criteria until the calculated sample size was reached.

 Procedure

Participants’ personal details and history were collected through a pre-designed questionnaire covering demographic, behavioral, social, and biological variables. Education level was classified according to the International Standard Classification of Education, and literacy was categorized as illiterate, primary, secondary, or graduate and above. Occupation was classified into workers (Government Employees, Private sector and unemployed). Smoking and alcohol consumption patterns were also recorded. A detailed family history of Type 2 Diabetes Mellitus (T2DM) was documented, with family history verified through blood glucose measurements or physician reports. Known T2DM cases were included, with details on the duration of diabetes. Blood pressure was measured in the sitting position, and participants were classified as hypertensive if diagnosed previously or if their systolic blood pressure (SBP) was >140 mmHg or diastolic blood pressure (DBP) was >90 mmHg.

Operational definitions and study measurements

Diabetic peripheral neuropathy (DPN): The existence of DPN was evaluated using the Michigan neuropathy screening instrument (MNSI). DPN was considered present if the patient's history version of the MNSI questionnaire score was ≥ 7 and/or if the examination version of the MNSI score was ≥ 2.57. (16,17)

Data analysis: 

The Statistical Package for the Social Sciences (SPSS) was employed to statistically summarise the data, including the mean, standard deviation, and median. A P-value of < 0.05 was deemed significant for all statistical analyses.

This investigation was performed with 184 diabetic patients. The prevalence of Diabetic Peripheral Neuropathy in our study was 52.74% (96/184). Of the 184 participants, 106 (57.60%) were female, and 78 (42.39%) were male (Table: 1).

Only 64 (34.7% of the total) of the participants live in rural areas, whereas the majority, 120 (65.21%), live in metropolitan areas.

Table: 1 Represents the Socio Demographic profile of Diabetic Patients

In terms of the participants' economic status, 29 patients (15.7%) had low incomes, 80 patients (43.7%) had medium incomes, and just 70 patients (40.7%) had high incomes. However, 138 patients, or 75% of the total, were determined to be unemployed. Most of the 162 diabetes patients in the current study (88.04%) were married.

Regarding participant obesity, 102 patients (55.43%) are not obese, while 82 patients (44.56%) are obese. Of the men, 125 (67.93%) were not smokers, 69.13 percent were drinkers, and 59 (32.06%) were smokers. Of the patients, about 65 (35.23%) were alcoholics.

Nearby, 90 patients (48.91%) had a family history of hypertension, and three-fourths of the participants (52.17%) had a family history of diabetes.

A statistically significant correlation was found with the participants ' age when using univariate analysis to determine the relationship between DPN and different risk factors. The prevalence of DPN was found to increase with age. Likewise, a statistically significant correlation was observed between the length of diabetes and the prevalence of DPN; the longer the duration of diabetes, the higher the prevalence (Table 2).

Table: 2 Represents the Socio Demographic profile and DPN among Study group

Additionally, a statistically significant correlation was seen between smoking history, family history of diabetes mellitus, systolic and diastolic blood pressure, and family history of hypertension. However, there was no discernible correlation between the participants' history of alcohol use and gender. When the multivariate analysis is applied, there is evident a substantial correlation between the participant's age, the length of their diabetes mellitus, and their smoking history, among the characteristics that have demonstrated a significant link in univariate analysis.

The high frequency of DPN in this study was explained by the fact that 17.39% of patients had fair glycaemic control, and 13.4% had poor glycaemic control (HbA1c > 8%). (Table 3)

Table: 3 Represents the association between risk factors and DPN among the study group

Subsequent multivariate analysis revealed that participant age, duration of diabetes mellitus, and smoking history were significant predictors of diabetic peripheral neuropathy (DPN).

Diabetes mellitus represents a major public health challenge for the global community in the 21st century (18). Diabetic peripheral neuropathy is the primary consequence of diabetes mellitus, significantly causing considerable physical and psychological distress to patients and their families, diminishing the patient's quality of life, and increasing mortality and disability rates. Thus, thoroughly comprehending the frequency and risk factors associated with DPN is crucial for enhancing preventive measures in patients diagnosed with DM. This study sought to determine the prevalence and associated risk factors of diabetic peripheral neuropathy in diabetic people.

A typical consequence of diabetes mellitus, diabetic peripheral neuropathy (DPN) frequently manifests as the initial symptom in people with DM. DPN can affect anywhere between 5% and 100% of people. Diabetic peripheral neuropathy was reported to be 52.74% prevalent in the current study (96/184). Similar results with a 19% prevalence among patients with diabetes mellitus were reported from south India. (19) Nonetheless, this is significantly greater than research done in Uttar Pradesh (20).

Of the 184 participants in the current study, 106 (57.60%) were female, and 78 (42.39%) were male. Similar outcomes were observed in research by Sendi RA et al. and others. (21-24).

The majority of study participants were over 60, with those in the 41–50 age range coming in second and third. Using univariate analysis, it was discovered that the prevalence of DPN rises with age. Likewise, the prevalence of DPN rises with the length of time a person has diabetes mellitus. This is consistent with the results of Soni et al., Darivemula S. et al., and other researchers. (25-28).

The current investigation found that participants with a family history of diabetes mellitus had a greater prevalence of DPN. This may be because people with a family history of diabetes mellitus are more likely to develop the disease early and to have it for a longer period, which puts them at risk for developing DPN. This is comparable to what another researcher found. (29).

A statistically significant correlation between systolic blood pressure, diastolic blood pressure, and family history of blood pressure was observed upon doing univariate analysis. The two variables shared non-modifiable risk factors may be the likely reason of this connection. Research by others (31-33) and Sanjay Dattatraya Bhalera et al. (30).

According to the current study, people with type 2 diabetes had a higher prevalence of DPN than those without the disease. These discrepancies resulted from variances in the number of patients of each kind and the statistical analysis included in our study. The high frequency of DPN in this study was explained by the fact that 17.39% of patients had fair glycaemic control, and 13.4% had poor glycaemic control (HbA1c > 8%). This could be due to differences in the availability of medical treatment, genetic susceptibility, and population knowledge.

Additionally, it was observed in this study that there is a statistically significant correlation between DPN and smoking history. Nearly 32.06% of the participants in this study reported having smoked in the past. Prasad et al. (33) and other researchers reported similar results (34, 35).

The correlation between HbA1c FBS and DPN is statistically significant. With a rise in HbA1c, DPN became more common. DPN was more common in individuals with an HbA1c >8% than in those with an HbA1c of 78%, and the latter group had a larger proportion of DPN than those with an HbA1c of <7%. Studies from India confirm this conclusion. (36,37).

Upon further application of multivariate analysis to variables that demonstrated statistically significant associations in univariate analysis, it was observed that a statistically significant correlation exists among the participant's age, duration of Diabetes mellitus, and smoking history. It was shown that the prevalence of diabetic peripheral neuropathy (DPN) escalates with advancing age. Diabetic peripheral neuropathy (DPN) is more common in older individuals and those with a prolonged duration of diabetes mellitus. Individuals of advanced age and prolonged duration may experience damage to the tiny blood arteries that supply oxygen and nutrients to the nerves. The multivariate analysis also identified a statistically significant relationship between smoking and DPN.

According to our study, 52.74% of people have diabetic-related neuropathy. The study also identifies risk factors for neuropathy, including a longer duration of diabetes, comorbid conditions like hypertension and dyslipidaemia, low socioeconomic status, missing hypoglycaemic medication doses more than five times per month, and poor glycaemic control. The current study reveals that diabetic peripheral neuropathy is highly frequent among people with diabetes mellitus. The prevalence escalates with advancing age and prolonged duration of Diabetes mellitus. The preliminary screening of DPN utilizing straightforward and economical methods Patients with diabetes mellitus should be encouraged to cease smoking and alcohol usage to mitigate the risk of diabetic peripheral neuropathy (DPN).  Individuals of advanced age and prolonged duration should be routinely tested for the signs and symptoms of diabetic peripheral neuropathy since they are at an elevated risk of acquiring this condition.

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