Exploring the burden of DPN and painful-DPN: insights from a large cohort study in the Northern Danish Region

Aims: This observational, cross-sectional survey study, performed in the Northern Danish Region, aimed to 1) investigate the associations between Painful and Painless Diabetic Peripheral Neuropathy (DPN) and QoL, mental health, and socioeconomic factors in a large, unselected population with diabetes compared with a group without DPN, 2) evaluate the prevalence of different sensory pain descriptors, and 3) evaluate the association between sensory pain descriptors and QoL, mental health, and socioeconomic factors.

Methods: The study distributed questionnaires digitally to all adults diagnosed with diabetes residing in the Northern Danish Region, based on electronic data registries. The survey consisted of validated questionnaires including: Michigan Neuropathy Screening Instrument Questionnaire (MNSIq); modified Doleur Neuropathique en 4 Questions (DN4-Interview); 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). Basic characteristics were collected, which were self-reported. Participants were grouped as having possible DPN if they have a MNSIq score of 4 or greater. Those with Painful-DPN were grouped as having possible Painful-DPN if they had an MNSIq score of 4 or more and a DN4-Interview of 3 or more.

Results: 6,960 participants with complete data were included in final analysis. A total of 23% of participants had possible DPN, with a high proportion of these reporting possible Painful-DPN (67.8%). Quality of life measured by SF-36 and mood (HADS) measures were worse in those with possible DPN compared to those without; and possible Painful-DPN was associated with worse quality of life and mental health compared with Painless-DPN. The most prevalent pain descriptor was burning pain (73%), followed by electric pain (43%). The most prevalent sensory descriptor was pins and needles (93%), followed by tingling (82%), numbness (55%), and itching (44%), with weak associations between neuropathic symptoms of electric shock/cold pain/itch and mental health/quality of life.

Conclusions: The study demonstrates the deleterious impact of DPN and Painful-DPN upon mental health and quality of life. Moreover, the study demonstrated the prevalence of different neuropathic symptoms in Painful-DPN and their relation to mental health/quality of life.

Comments: These findings reinforce the substantial burden that Painful-DPN places on patients in a large cohort. A major strength of the study is its use of validated questionnaires, which enabled exploration of the relationship between neuropathic symptoms and mental health/quality of life. However, self-reported questionnaire-based studies such as this have inherent limitations, including the risk of response bias and the absence of clinical confirmation of DPN and neuropathic pain diagnoses. This study confirmed that burning is the most prevalent symptom in individuals with Painful-DPN. Additionally, it identified itch as a common yet relatively unexplored symptom. Importantly, itch showed the strongest correlations with anxiety and depression, suggesting that this under-researched symptom warrants further investigation in future studies.

Gordon Sloan

Reference: Borbjerg MK, Wegeberg AM, Nikontovic A, Mørch CD, Arendt-Nielsen L, Ejskjaer N, Brock C, Vestergaard P, Røikjer J. Understanding the Impact of Diabetic Peripheral Neuropathy and Neuropathic Pain on Quality of Life and Mental Health in 6,960 People With Diabetes. Diabetes Care. 2025 Feb 11:dc242287. doi: 10.2337/dc24-2287. Epub ahead of print. PMID: 39932781.

🔗 https://diabetesjournals.org/care/article-abstract/doi/10.2337/dc24-2287/157862/Understanding-the-Impact-of-Diabetic-Peripheral?redirectedFrom=fulltext