Painful Diabetic Neuropathy Lowers Quality of Life and Increases Anxiety

Painful diabetic peripheral neuropathy (DPN) is associated with significantly lower quality of life (QoL), increased anxiety and depression, and potential socioeconomic impacts relative to painless DPN and absence of DPN, according to study results published in Diabetes Care.

To investigate the associations between painful and painless DPN and QoL, mental health, and socioeconomic factors among a large, unselected population with diabetes, researchers conducted an observational, cross-sectional survey in the Northern Danish Region in November 2022. Data were collected via a regional digital questionnaire distributed to adults with diabetes using the Danish National Patient Registry.

The survey included 7743 individuals with diabetes, of whom 60% were men, with a mean age of 65 years. After exclusion of 783 participants due to incomplete socioeconomic and mental health data, the final cohort comprised 980 individuals with type 1 diabetes, 5965 with type 2 diabetes, and 15 with other types. The median diabetes duration was 10 years.

Comparisons between those with and without possible DPN (n=1601) revealed that individuals with possible DPN had significantly higher anxiety (median Hospital Anxiety and Depression Scale anxiety subscale [HADS-A], 5.00 vs 2.00; P <.001) and depression (median HADS depression subscale [HADS-D], 4.00 vs 1.00; P <.001) scores.

Within the DPN group, 1085 had painful DPN, while 516 had painless DPN. Those with painful vs painless DPN reported significantly worse QoL (median 36-item Short Form Health Survey [SF-36], 45.0 vs 67.5; P <.001) and higher rates of anxiety (38.7% vs 27.7%; P <.001) and depression (27.5% vs 20.5%; P =.004).

The most common pain descriptor was burning pain (73%), followed by electric pain (43%) and cold pain (31%). Sensory symptoms included pins and needles (93%), tingling (82%), numbness (55%), and itching (44%). Socioeconomic factors did not differ significantly between the painful and painless DPN groups.

Subgroup analyses by diabetes type revealed that both DPN and painful DPN were more strongly associated with reduced QoL among individuals with type 1 diabetes. In contrast, individuals with type 2 diabetes exhibited stronger associations between DPN and anxiety/depression, though neuropathic pain itself was not a significant predictor of these mental health outcomes.

Correlation analysis showed weak but significant associations between sensory pain descriptors and mental health, with electric pain (r=0.118; P <.001) and itching (r=0.169; P <.001) correlating with anxiety, and cold pain (r=0.125; P <.001), electric pain (r=0.128; P <.001), and itching (r=0.133; P <.001) correlating with depression.

QoL was negatively associated with:

• Cold pain (r= –0.193; P <.001);
• Electric pain (r= –0.114; P <.001);
• Itching (r= –0.159; P <.001); and,
• Numbness (r= –0.121; P <.001).

Study limitations include the inability to address causality, the diagnosis of DPN did not include a clinical assessment, and the survey results may have been affected by pain in other locations.

The study authors concluded, “The current study showed that DPN with concomitant neuropathic pain impacts QoL and mental health negatively and likewise for DPN without neuropathic pain.”

This article originally appeared on Endocrinology Advisor