Currently, the prevalence of type 2 diabetes(T2D) in India is estimated at 10.4%, with approximately 70 million adultshaving T2D. Globally, India ranks second after China in the number of adultswith T2D.
1 The prevalence of T2D has more than doubled in the lasttwo decades, reaching epidemic proportions. Moreover, the prevalence ofprediabetes in India is higher than that of T2D at approximately more than 77million.2 Prediabetes is not only a strong risk factor for futuredevelopment of diabetes, but also for microvascular complications andcardiovascular disease.3 In addition, microvascular complications ofdiabetes could manifest during the prediabetes stage.4Diabetic peripheral neuropathy (DPN) is among themost common microvascular complications of diabetes and is associated withincreased morbidity, economic encumbrance, and diminished quality of life.
5Distal symmetrical polyneuropathy (DSPN), the most common presentation of DPN,involves the somatic and autonomic nerve fibers. Its somatic component may bemanifested by pain, paresthesia, cramps, or muscle weakness, predominantly inthe lower limbs. Patients with DSPN may barely recognize its progression.
Debilitatingneuropathic pain frequently occurs in patients with DSPN and is often difficultto manage.6, 7 Foot ulceration and amputation are the two majorcomplications of DSPN. In India, the traditional risk factors like poorglycemic control are compounded by the practice of bare foot walking,nutritional deficiencies, poor foot hygiene, and improper foot wear.8The absence of symptoms in the early stages, lack of reliable diagnostictechniques, regular screening programs, and poor awareness all contribute todelayed diagnosis.
8, 9 DPN affects more than 50% of patients withlong-standing T2D, and it may be a presenting feature of diabetes in elderlypatients.10 Several recent studies have consistently reported theoccurrence of DPN in participants with impaired glucose tolerance (IGT) andprediabetes.11-13 Early neuropathy associated with prediabetes isthe focus of current research as it may be the most responsive to noveltherapies targeting different pathophysiological pathways of DPN. Early diagnosisis also important for optimizing glycemic control, patient education on footcare practices, and implementing preventive measures. Moreover, screeningstrategies for early detection of neuropathy and foot care education have beenshown to reduce the incidence of foot ulceration and amputation. 14, 15 Data on the prevalence of DPN in prediabetesamong Indians are sparse. Given the burden of prediabetes and the potentialcomplications associated with DPN, having an estimate of the prevalence of DPNin prediabetes and understanding the factors influencing its occurrence areimportant.
Hence, the objective of the present study is to estimate theprevalence of DPN in prediabetes among Indians and to identify the maindeterminants of DPN.