A large nationwide study on the prevalence of peripheral neuropathy in type 2 diabetes in Greece: the PRENEDIG study

Aims: This study aimed to assess the prevalence and risk factors of diabetic peripheral neuropathy (DPN) in adult Greek subjects with type 2 diabetes mellitus (T2DM).

Methods: It was a cross-sectional multicentre study involving hospital-based diabetes clinics and primary care practices. DPN prevalence and severity were evaluated using the Neuropathy Symptom Score (NSS) and the Neuropathy Disability Score (NDS). DPN diagnosis required the presence of NDS ≥6 or of NDS ≥3 and NSS ≥5. Additional sensory assessment tools were considered to support clinical evaluation. Multivariate regression analysis examined the association between DPN and potential risk factors.

Results: Among the study population (n=1807), the overall DPN prevalence was 18.87% and increased with longer diabetesduration. DPN prevalence among participants with over 10 years of T2DM reached 26.49%. Logistic regression analysis identified several independent predictors of DPN including diabetes duration >10 years (p<0.001), arterial hypertension in participants with diabetes
duration <10 years (OR=2.69, CI: 1.68–4.30, p<0.001), HbA1c levels (OR=1.20, CI: 1.10–1.31, p<0.001), and age (OR=1.02, CI: 1.00–1.03, p=0.024).

Conclusions: In Greece, DPN is a common complication, affecting nearly one in
five T2DM patients. The results of the study reinforce the importance of routine screening, particularly among older patients and those with longer diabetes duration to facilitate early detection and timely management of DPN and its associated complications.

Comments: The PRENEDIG study represents a landmark effort, providing the first nationwide, real-world assessment of DPN prevalence and associated risk factors among Greek adults with T2DM.

One of the major strengths of PRENEDIG lies in its large, nationally representative sample, which included 1807 patients recruited from both primary care settings and specialized diabetes clinics across Greece. This broad recruitment strategy enhances the external validity and generalizability of the findings to routine clinical practice. Furthermore, the use of validated clinical instruments, namely the NSS and NDS, strengthens the diagnostic accuracy and reproducibility of DPN assessment. Importantly, the study does not rely solely on patient-reported symptoms, but incorporates objective neurological examination, including vibration perception and monofilament testing.

Nonetheless, certain limitations should be acknowledged. Assessment of DPN was conducted solely using the NSS and NDS scales, without additional clinical diagnostic tools (e.g., EMG), as such tools are not commonly available in primary care settings in Greece. Accordingly, comorbidities including diabetic complications were documented as either present or absent based exclusively on existing
medical records, without supplementary clinical evaluation. Finally, the cross-sectional nature of the study restricts the ability to draw causal inferences.

Eleni Karlafti

Reference. Migdalis IN, Tentolouris NK, Didangelos TP, Papanas N, Bristianou MX, Mavrogiannaki AN, On Behalf Of The Prenedig Study. A Nationwide Study on the Prevalence of Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus in Greece-The PRENEDIG Study. J Clin Med. 2025 Sep 23;14(19):6723. doi: 10.3390/jcm14196723. PMID: 41095802; PMCID: PMC12525474.

🔗 https://pmc.ncbi.nlm.nih.gov/articles/PMC12525474/pdf/jcm-14-06723.pdf