Frequency of Peripheral Neuropathy in Diabetic Patients with and Without Anemia: An Analytical Comparative Cross-Sectional Study
DOI:
https://doi.org/10.65761/pjcr.2026.281Keywords:
Diabetic Neuropathies, Anemia, Peripheral Nervous System Diseases, Cross-Sectional Studies, Risk FactorsAbstract
Background: Diabetic peripheral neuropathy (DPN) is a common complication of diabetes, causing sensory loss, pain, gait impairment, ulcers, and amputation. Its substantial burden in Pakistan warrants systematic screening, while anemia and vitamin B12 deficiency may further contribute to neuropathic clinical manifestations.
To evaluate the DPN frequency in patients with and without anemia in diabetic patients to determine the independent predictors.
Methods: 192 adults type 2 diabetes were studied using an analytic comparative cross-sectional framework, consisting of equal representation of anemia and non-anemia groups. A standardized examination based on the Michigan Neuropathy Screening Instrument was used to make the assessment of DPN. There was a group comparison, estimates of effects and multivariate logistic regression.
Results: DPN was present in 92/192 (47.9%; 95% CI 40.7-55.2). Neuropathy occurred in 58/96 (60.4%) participants with anemia versus 34/96 (35.4%) without anemia (p<0.001), giving a crude OR of 2.78 (95% CI 1.55-5.00). HbA1c, age, vitamin B12 deficiency had no independent association with diabetes due to the duration of the diabetes (aOR 2.78, 95% CI 1.42-5.42; p=0.003). Predictors were also found to be longer period of diabetes, elevated HbA1c, and age. The model AUC was 0.800.
Conclusion: Anemia was linked with a significantly greater prevalence of DPN among adults with type 2 diabetes and can be used to define a population that needs the increase of neurological and hematological screening.
References
1. Akhtar S, Hassan F, Saqlain SR, Ali A, Hussain S. The prevalence of peripheral neuropathy among the patients with diabetes in Pakistan: a systematic review and meta-analysis. Sci Rep. 2023;13(1):11744. DOI: https://doi.org/10.1038/s41598-023-39037-1
2. Alvarez M, Prieto AE, Portilla N, Moya D, Rincon O, Guzman I. Metformin-induced vitamin B12 deficiency: an underdiagnosed cause of diabetic neuropathy. World J Diabetes. 2025;16(7):107514. DOI: https://doi.org/10.4239/wjd.v16.i7.107514
3. Bell DSH. Metformin-induced vitamin B12 deficiency can cause or worsen distal symmetrical, autonomic and cardiac neuropathy in the patient with diabetes. Diabetes Obes Metab. 2022;24(8):1423-1428. DOI: https://doi.org/10.1111/dom.14734
4. Chang KC, Pai YW, Lin CH, Lee IT, Chang MH. Glycemic variability's impact on painful diabetic peripheral neuropathy in type 2 diabetes patients. Sci Rep. 2024;14(1):22276. DOI: https://doi.org/10.1038/s41598-024-73472-y
5. Chew SM, Avinashi SD, Venkataraman K. Predictors of incident diabetic peripheral neuropathy: a systematic review of longitudinal studies in patients with diabetes mellitus. Rev Endocr Metab Disord. 2025;26(4):659-677. DOI: https://doi.org/10.1007/s11154-025-09973-6
6. Davis TME, Chubb SAP, Peters KE, Davis WA. Serum vitamin B12, distal symmetrical polyneuropathy and anaemia in type 2 diabetes: the Fremantle Diabetes Study Phase 2. Intern Med J. 2024;54(4):575-581. DOI: https://doi.org/10.1111/imj.16225
7. Farooqi M, Tahir Y, Rehan B. Anemia in patients with type 2 diabetes: a common but neglected clinical finding. Acta Biomed. 2022;93(1):e2022044. DOI: https://doi.org/10.23750/abm.v93i1.11204
8. Gao L, Ran X, Liu X, Shen X, Chen S, Liu F, et al. The effects of daily dose and treatment duration of metformin on the prevalence of vitamin B12 deficiency and peripheral neuropathy in Chinese patients with type 2 diabetes mellitus. J Diabetes. 2023;15(9):765-776. DOI: https://doi.org/10.1111/1753-0407.13428
9. Hap K, et al. Validity and reliability of the Polish version of the Michigan Neuropathy Screening Instrument. World J Diabetes. 2023;14(4):435-447. DOI: https://doi.org/10.4239/wjd.v14.i4.435
10. Hayat T, Waqar R, Farsi S, Ali S, Asim M, Farooq U. Vitamin B12 deficiency in patients with diabetic peripheral neuropathy: a hospital-based cross-sectional study. Cureus. 2025;17(7):e87490. DOI: https://doi.org/10.7759/cureus.87490
11. Jin HY, Kim J, Lee KA, et al. Bidirectional association between diabetic peripheral neuropathy and vitamin B12 deficiency: two longitudinal 9-year follow-up studies using a national sample cohort. Prim Care Diabetes. 2023;17(5):445-452. DOI: https://doi.org/10.1016/j.pcd.2023.06.006
12. Lan L, Wang L, Sadeghirad B, Tang J, Liu Y, Couban RJ, et al. Acupuncture for the management of chronic diabetic peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials. Curr Pain Headache Rep. 2025;29(1):74. DOI: https://doi.org/10.1007/s11916-025-01386-z
13. Liu J, Yuan X, Liu J, Yuan G, Sun Y, Zhang D, et al. Risk factors for diabetic peripheral neuropathy, peripheral artery disease, and foot deformity among the population with diabetes in Beijing, China. Front Endocrinol (Lausanne). 2022;13:824215. DOI: https://doi.org/10.3389/fendo.2022.824215
14. Liu J, Zhang Q, et al. Diabetic peripheral neuropathy and glycemic variability assessed by continuous glucose monitoring: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2024;214:111757. DOI: https://doi.org/10.1016/j.diabres.2024.111757
15. Matalqah LM, Yehya A, Radaideh KM. Pharmacist-lead screening for diabetic peripheral neuropathy using Michigan Neuropathy Screening Instrument. Int J Neurosci. 2024;134(8):882-888. DOI: https://doi.org/10.1080/00207454.2022.2154671
16. Mazumder H, Islam KF, Rahman F, Gain EP, Saha N, Eva IS, et al. Prevalence of anemia in diabetes mellitus in South Asia: a systematic review and meta-analysis. PLoS One. 2023;18(5):e0285336. DOI: https://doi.org/10.1371/journal.pone.0285336
17. Naghizadeh S, Zohrabi-Fard M, Keramati AA, Zali A, Oraii Yazdani K, Rohani S, et al. Surgical nerve decompression at lower extremity for diabetic neuropathy: a systematic review and meta-analysis. World Neurosurg. 2025;199:124114. DOI: https://doi.org/10.1016/j.wneu.2025.124114
18. Perveen W, Ahsan H, Shahzad R, Fayyaz S, Zaif A, Paracha MA, et al. Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus. Sci Rep. 2024;14(1):14430. DOI: https://doi.org/10.1038/s41598-024-65495-2
19. Ponirakis G, Elhadd T, Al Ozairi E, Brema I, Chinnaiyan S, Taghadom E, et al. Prevalence and risk factors for diabetic peripheral neuropathy, neuropathic pain and foot ulceration in the Arabian Gulf region. J Diabetes Investig. 2022;13(9):1551-1559. DOI: https://doi.org/10.1111/jdi.13815
20. Pratama S, Lauren BC, Wisnu W. The efficacy of vitamin B12 supplementation for treating vitamin B12 deficiency and peripheral neuropathy in metformin-treated type 2 diabetes mellitus patients: a systematic review. Diabetes Metab Syndr. 2022;16(10):102634. DOI: https://doi.org/10.1016/j.dsx.2022.102634
21. Tao Y, Zhang HY, MacGilchrist C, Kirwan E, McIntosh C. Prevalence and risk factors of painful diabetic neuropathy: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2025;222:112099. DOI: https://doi.org/10.1016/j.diabres.2025.112099
22. Vinelli-Arzubiaga D, Suasnabar Campos CE, Laso-Salazar MC, Abarca-Barriga H. Polymorphic variants and risk of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus: systematic review and meta-analysis. BMC Endocr Disord. 2025;25(1):69. DOI: https://doi.org/10.1186/s12902-025-01897-1
23. Viswanathan V, Khan BA, Nachimuthu S, Kumpatla S. Precision of Michigan Neuropathy Screening Instrument tool for the diagnosis of diabetic peripheral neuropathy among people with type 2 diabetes. Int J Low Extrem Wounds. 2025;24(4):1152-1158. DOI: https://doi.org/10.1177/15347346231163209
24. Yang R, Yu H, Wu J, Chen H, Wang M, Wang S, et al. Metformin treatment and risk of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus in Beijing, China. Front Endocrinol (Lausanne). 2023;14:1082720. DOI: https://doi.org/10.3389/fendo.2023.1082720
25. Zhang Y, Sun W, Zhang Q, Bai Y, Ji L, Zheng H, et al. Estimated glucose disposal rate predicts the risk of diabetic peripheral neuropathy in type 2 diabetes: a 5-year follow-up study. J Diabetes. 2024;16(5):e13482. DOI: https://doi.org/10.1111/1753-0407.13482
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Farhat Ullah Bakhsh, Shamaila Burney
This work is licensed under a Creative Commons Attribution 4.0 International License.
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
