Potential risk factors for peripheral neuropathy in patients with type 2 diabetes mellitus: a case control study from central Rajasthan

Govind R. Patel, Anil Samaria, Chandra Kant, Gopal R. Prajapati


Background: Peripheral neuropathy is one of the most common and debilitating but preventable complications of diabetes mellitus, with significant morbidity as it often leads to foot ulceration and amputation. Therefore, this study was aimed to identify the potential risk factors for diabetic peripheral neuropathy (DPN) which can affect its progression.

Methods: This case-control study was conducted on 240 patients with type 2 diabetes mellitus which included 120 patients with clinical evidence of DPN as cases and 120 patients without clinical evidence of DPN as controls. DPN was assessed clinically by neuropathic symptoms and neurological examination using 10 g 5.07 Semmes–Weinstein monofilament and vibration digital biothesiometer. Data regarding presence of potential risk factors were collected from all participants and analyzed using logistic regression analysis to measure an association with DPN.

Results: A significant and independent association of advancing age, longer duration of diabetes, hyperglycemia, poor glycemic control, autonomic neuropathy and retinopathy with DPN (p<0.05) was observed. Hypertension, dyslipidemia, smoking, gender, body mass index, method of diabetes control and angiotensin converting enzyme inhibitor usage were not found be associated with DPN.

Conclusions: Since hyperglycemia and poor glycemic control were only modifiable risk factors for DPN, intensive glycemic control and primary prevention are the cornerstones for reducing the incidence or slowing the progression of neuropathy and improving quality of life in diabetic patients.  


Diabetes mellitus, Type 2 diabetes mellitus, diabetic peripheral neuropathy, glycemic control, hyperglycemia, risk factors

Full Text:



International Diabetes Federation. IDF diabetes atlas 2021. 10th ed. Available at Accessed 9 February 2022.

Shobana R, Augustine C, Ramachandran A, Vijay V. Improving psychosocial care: the Indian experience. Diabetes Voice 2005;50:19-21.

Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 2010;33:2285-93.

Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population‑based cohort. Neurology 1993;43:817‑24.

Feldman EL, Russell JW, Sullivan KA, Golovoy D. New insights into the pathogenesis of diabetic neuropathy. Curr Opin Neurol 1999;12:553-63.

Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med 2005;352:341-50.

Jember G, Melsew YA, Fisseha B, Sany K, Gelaw AY, Janakiraman B. Peripheral sensory neuropathy and associated factors among adult diabetes mellitus patients in Bahr Dar, Ethiopia. J Diabetes Metab Disord 2017;16:16.

Kiani J, Moghimbeigi A, Azizkhani H, Kosarifard S. The prevalence and associated risk factors of peripheral diabetic neuropathy in Hamedan, Iran. Iran. Arch Iran Med 2013;16:17-9.

Dyck PJ, Karnes JL, Daube J, O'Brien P, Service FJ. Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy. Brain 1985;108:861-80.

Afroz A, Ali L, Karim MN, Alramadan MJ, Alam K, Magliano DJ, et al. Glycaemic Control for People with Type 2 Diabetes Mellitus in Bangladesh - An urgent need for optimization of management plan. Sci Rep 2019;9:10248.

American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes care 2014;37(Supp1):S14–80.

Bansal D, Gudala K, Muthyala H, Esam HP, Nayakallu R, Bhansali A. Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting. J Diabetes Investig 2014;5:714‑21.

Lu B, Hu J, Wen J, Zhang Z, Zhou L, Li Y, et al. Determination of peripheral neuropathy prevalence and associated factors in Chinese subjects with diabetes and pre-diabetes - ShangHai Diabetic neuRopathy Epidemiology and Molecular Genetics Study (SH-DREAMS). PLoS One 2013;8:e61053.

Booya F, Bandarian F, Larijani B, Pajouhi M, Nooraei M, Lotfi J. Potential risk factors for diabetic neuropathy: A case control study. BMC Neurol 2005;5:24.

D’Souza M, Kulkarni V, Bhaskaran U, Ahmed H, Naimish H, Prakash A, et al. Diabetic peripheral neuropathy and its determinants among patients attending a tertiary health care centre in Mangalore, India. J Public Health Res 2015;4:450-55.

Dutta A, Naorem S, Singh TP, Wangjam K. Prevalence of peripheral neuropathy in newly diagnosed type 2 diabetics. Int J Diabetes Dev Ctries 2005;25:30‑3.

Mørkrid K, Ali L, Hussain A. Risk factors and prevalence of diabetic peripheral neuropathy: A study of type 2 diabetic outpatients in Bangladesh. Int J Diabetes Dev Ctries 2010;30:11‑7.

Tesfaye S, Stevens LK, Stephenson JM, Fuller JH, Plater M, Ionescu-Tirgoviste C, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycemic control and potential risk factors. The Euro Diab IDDM Complications study. Diabetologia 1996;39:977-81.

Ashok S, Ramu M, Deepa R, Mohan V. Prevalence of neuropathy in type 2 diabetic patients attending a diabetes centre in South India. J Assoc Physicians India 2002;50:546-50.

Gogia S, Rao CR. Prevalence and risk factors for peripheral neuropathy among type 2 diabetes mellitus patients at a tertiary care hospital in coastal Karnataka. Indian J Endocr Metab 2017;21:665-9.

Mimi O, Teng CL, Chia YC. The prevalence of diabetic peripheral neuropathy in an outpatient setting. Med J Malaysia 2003;58:533–38.

Maser RE, Steenkiste AR, Dorman JS, Nielsen VK, Bass EB, Manjoo Q, et al. Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh Epidemiology of Diabetes Complication Study. Diabetes 1989;38:1456-61.

Edwards JL, Vincent A, Cheng T, Feldman EL. Diabetic neuropathy : mechanisms to management. Pharmacol Ther 2008;120:1–34.

Nisar MU, Asad A, Waqas A, Ali N, Nisar A, Qayyum MA, et al. Association of diabetic neuropathy with duration of type 2 diabetes and glycemic control. Cureus 2015;7:e302.

Hillson RM, Hockaday TD, Newton DJ. Hyperglycaemia is one correlate of deterioration in vibration sense during the 5 years after diagnosis of type 2 (non‑insulin‑dependent) diabetes. Diabetologia 1984;26:122‑6.

Pirat J. Diabetes mellitus and its degenerative complication: a prospective study of 4400 patients observed between 1947 and 1973. Diabetes care 1978;1:168-88.

Battula P, Afreen S, Meena E, Siva Ram Reddy S, Sujatha G. Prevalence of sensory peripheral neuropathy in diabetic patients at diabetes care centre: a cross sectional study. Int J Res Med Sci 2017;5:4066-71.

Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus. N Engl J Med 1993;329:977-86.

Alvarsson M, Sundkvist G, Lager I, Henricsson M, Berntorp K, Fernqvist-Forbes E, et al. Beneficial effects of insulin versus sulphonylurea on insulin secretion and metabolic control in recently diagnosed type 2 diabetic patients. Diabetes Care 2003;26:2231-7.

Qiang X, Satoh J, Sagara M, Fukuzawa M, Masuda T, Miyaguchi S, et al. Gliclazide inhibits diabetic neuropathy irrespective of blood glucose levels in streptozotocin-induced diabetic rats. Metabolism 1998;47:977-81.