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. 2025 May 13:16:1564867.
doi: 10.3389/fneur.2025.1564867. eCollection 2025.

Prevalence and risk factors for painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Peng Zhou #  1 , Jin Song Zhou #  2   3   4 , Jin Jie Li  2   3   4 , Lang Qin  1 , Wen Feng Hu  1 , Xiao Yi Zhang  1 , Jian Xia Wang  2   3   4 , Zhen Shi  2   3   4
Affiliations

Prevalence and risk factors for painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Peng Zhou et al. Front Neurol. .

Abstract

Objective: This study aimed to explore the prevalence and risk factors for painful diabetic peripheral neuropathy through meta-analysis, and to provide countermeasures for early intervention and active prevention of diabetic peripheral neuropathic pain.

Methods: We conducted a systematic search of PubMed, Embase, Web of Science, and Cochrane Library for articles published from the establishment of the database to November 2024. A total of 14 studies (nine cross-sectional studies and five cohort studies) qualified for meta-analysis. We used a random-effects meta-analysis and assessed heterogeneity and publication bias.

Results: A total of 14 studies (nine cross-sectional, five cohort) were included. The prevalence of PDPN was estimated at 33.9% (95% CI [19.4%-48.5%]). Significant risk factors included female gender (OR = 1.29, P = 0.004), glycosylated hemoglobin levels (WMD = 0.14, P < 0.001), nephropathy (OR = 1.41, P < 0.001), retinopathy (OR = 1.32, P = 0.040), cardiovascular disease (OR = 1.46, P < 0.001), arterial hypertension (OR = 1.25, P = 0.047), triglycerides levels (WMD = -0.10, P < 0.001), low density lipoprotein levels (WMD = -0.20, 1. 0.001), smoking (OR = 0.90, P = 0.001), drinking alcohol (OR = 0.87, P = 0.001), glomerular filtration rate levels (WMD = -7.11, P < 0.001), obesity (OR = 2.00, P = 0.001). The multivariate analysis results showed that female gender (OR = 1.42, P = 0.032), age of onset (OR = 1.19, P < 0.001), duration of diabetes (OR = 1.29, P < 0.001), and retinopathy (OR = 1.90, P = 0.032) were indicated as risk factors for painful diabetic peripheral neuropathy.

Conclusion: This meta-analysis suggests that female gender, glycosylated hemoglobin levels, nephropathy, retinopathy, cardiovascular disease, arterial hypertension, smoking, drinking alcohol, glomerular filtration rate levels, obesity, age of onset and duration of diabetes are indicated as risk factors for painful diabetic peripheral neuropathy in diabetic patients.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42025629060.

Keywords: diabetes mellitus (DM); meta-analysis; painful diabetic peripheral neuropathy (PDPN); risk factor; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the literature search.
Figure 2
Figure 2
Forest plot of the meta-analysis of the prevalence of PDPN.
Figure 3
Figure 3
Sensitivity analysis of the prevalence of PDPN.
Figure 4
Figure 4
Egger test of the prevalence of PDPN.
Figure 5
Figure 5
Forest plot of the meta-analysis of female gender.
Figure 6
Figure 6
Forest plot of the meta-analysis of glycosylated hemoglobin levels.
Figure 7
Figure 7
Forest plot of the meta-analysis of concomitant nephropathy.
Figure 8
Figure 8
Forest plot of the meta-analysis of associated retinopathy.
Figure 9
Figure 9
Forest plot of the meta-analysis of concomitant cardiovascular disease.
Figure 10
Figure 10
Forest plot of the meta-analysis of arterial hypertension.
Figure 11
Figure 11
Forest plot of the meta-analysis of triglycerides levels.
Figure 12
Figure 12
Forest plot of the meta-analysis of low density lipoprotein levels.
Figure 13
Figure 13
Forest plot of the meta-analysis of smoking.
Figure 14
Figure 14
Forest plot of the meta-analysis of drinking alcohol.
Figure 15
Figure 15
Forest plot of the meta-analysis of glomerular filtration rate levels.
Figure 16
Figure 16
Forest plot of the meta-analysis of obesity.
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