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Multicenter Study
. 2025 Jun;16(6):1045-1049.
doi: 10.1111/jdi.70033. Epub 2025 Mar 27.

Severe insulin-deficient diabetes is at the opposite end of the neuropathy spectrum to mild aged-related diabetes

Brian C Callaghan  1 , Ranjit Mohan Anjana  2 , Lavanya Muthukumar  1 , Evan L Reynolds  3 , Jebarani Saravanan  2 , Mani Arun Vignesh  2 , Aswin Mukundan  2 , Eva L Feldman  1 , Viswanathan Mohan  2
Affiliations
Multicenter Study

Severe insulin-deficient diabetes is at the opposite end of the neuropathy spectrum to mild aged-related diabetes

Brian C Callaghan et al. J Diabetes Investig. 2025 Jun.

Abstract

The effect of diabetes subtypes on neuropathy prevalence and metabolic drivers of this relationship are unknown. Using electronic medical records from 50 diabetes care centers in eight states of India with biothesiometer and complete phenotyping data on 22,348 patients, we determined neuropathy prevalence stratified by India-specific diabetes subtypes and evaluated associations with neuropathy (biothesiometer). Neuropathy prevalence was highest in severe insulin-deficient diabetes (SIDD; 25.5%), followed by insulin-resistant obese diabetes (IROD; 21.8%), mild age-related diabetes (MARD; 18.9%), and combined insulin-resistant and deficient diabetes (CIRDD; 17.3%, P = <0.001). HbA1c (odds ratio [OR]: 1.19, 1.16-1.21), diabetes duration (OR: 1.04, 1.04-1.05), and waist circumference (OR: 1.01, 1.01-1.02) were associated with neuropathy. SIDD (OR: 2.23, 2.01-2.47), CIRDD (OR: 1.89, 1.69-2.11), and IROD (OR: 1.84, 1.66-2.04) had increased neuropathy compared to MARD. In India, SIDD patients are more likely to have neuropathy compared to MARD patients likely from longer diabetes duration and higher HbA1c; therefore, interventions should focus on hyperglycemia. Interventions in CIRDD and IROD patients should likely address obesity as well.

Keywords: Diabetes subtypes; India; Neuropathy.

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Conflict of interest statement

Dr. Callaghan consults for DynaMed, receives research support from the American Academy of Neurology, is an editor for the Neurology journal, and performs medical legal consultations including consultations for the Vaccine Injury Compensation Program. Dr. Anjana, Mrs. Muthukumar, Dr. Reynolds, Mrs. Jebarani, Mr. Mani Arun Vignesh, Dr. Aswin, Dr. Feldman, and Dr. Mohan report no disclosures.

Approval of the research protocol: N/A.

Informed consent: Participants provided informed consent. This study was exempt because it involved a retrospective analysis of de‐identified data.

Approval date of registry and the registration no. of the study/trial: N/A.

Animal studies N/A.

Figures

Figure 1
Figure 1
Flow sheet of patients eligible for the study based on metabolic phenotyping and neuropathy outcome data. BMI, body mass index; HDL, high‐density lipoprotein; rMNSIq, reduced Michigan Neuropathy Screening Instrument questionnaire; T2DM, type 2 diabetes; VPT, vibration perception threshold.
See this image and copyright information in PMC

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