Predictors of incident diabetic peripheral neuropathy: a systematic review of longitudinal studies in patients with diabetes mellitus

Abstract

Diabetic peripheral neuropathy (DPN) is a debilitating complication of diabetes, with limited treatment options. This systematic review consolidates longitudinal studies on the development of DPN, identifying key predictors to inform clinical interventions for DPN prevention. PubMed, Embase, and Cochrane databases were searched for peer-reviewed studies on DPN published before March 2024. Longitudinal studies involving populations with diabetes and investigating sociodemographic, lifestyle, anthropometric, and clinical predictors of DPN were included. Studies with missing data or high risk of bias were excluded. Predictors of DPN were extracted from included studies and recorded in an Excel file. Weighted mean differences (continuous variables) and relative risks (dichotomous variables) were calculated to assess predictors' significance. Twenty-seven studies analyzing 21 predictors were included. The median sample size and follow-up time were 985 and 72 months respectively. Age, HbA1c, BMI, diabetes duration, and systolic blood pressure were strong positive predictors of incident DPN, highlighting the role of glycemic control, weight management, and blood pressure optimization in reducing DPN risk. Modest associations were found for fasting plasma glucose, smoking, height, weight, waist circumference, sex, use of antihyperlipidemia drugs, and retinopathy. A subgroup analysis demonstrated that these findings were relevant to both Type 1 and Type 2 diabetes. Despite the heterogeneity observed in DPN diagnostic criteria and measurements of predictors across studies, several potentially modifiable risk factors for DPN were identified. These findings can help healthcare providers identify high-risk individuals and implement appropriate preventive measures targeting these factors for reducing the risk of DPN development.

Keywords: Diabetes mellitus; Diabetic peripheral neuropathy; Longitudinal studies; Meta-analysis; Neuropathy; Systematic review.