Currently, patients with DSPN and is often difficult to

Currently, the prevalence of type 2 diabetes
(T2D) in India is estimated at 10.4%, with approximately 70 million adults
having T2D. Globally, India ranks second after China in the number of adults
with T2D.1 The prevalence of T2D has more than doubled in the last
two decades, reaching epidemic proportions. Moreover, the prevalence of
prediabetes in India is higher than that of T2D at approximately more than 77
million.2 Prediabetes is not only a strong risk factor for future
development of diabetes, but also for microvascular complications and
cardiovascular disease.3 In addition, microvascular complications of
diabetes could manifest during the prediabetes stage.4

Diabetic peripheral neuropathy (DPN) is among the
most common microvascular complications of diabetes and is associated with
increased morbidity, economic encumbrance, and diminished quality of life.5
Distal symmetrical polyneuropathy (DSPN), the most common presentation of DPN,
involves the somatic and autonomic nerve fibers. Its somatic component may be
manifested by pain, paresthesia, cramps, or muscle weakness, predominantly in
the lower limbs. Patients with DSPN may barely recognize its progression. Debilitating
neuropathic pain frequently occurs in patients with DSPN and is often difficult
to manage.6, 7 Foot ulceration and amputation are the two major
complications of DSPN. In India, the traditional risk factors like poor
glycemic control are compounded by the practice of bare foot walking,
nutritional deficiencies, poor foot hygiene, and improper foot wear.8
The absence of symptoms in the early stages, lack of reliable diagnostic
techniques, regular screening programs, and poor awareness all contribute to
delayed diagnosis.8, 9  

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DPN affects more than 50% of patients with
long-standing T2D, and it may be a presenting feature of diabetes in elderly
patients.10 Several recent studies have consistently reported the
occurrence of DPN in participants with impaired glucose tolerance (IGT) and
prediabetes.11-13 Early neuropathy associated with prediabetes is
the focus of current research as it may be the most responsive to novel
therapies targeting different pathophysiological pathways of DPN. Early diagnosis
is also important for optimizing glycemic control, patient education on foot
care practices, and implementing preventive measures. Moreover, screening
strategies for early detection of neuropathy and foot care education have been
shown to reduce the incidence of foot ulceration and amputation. 14, 15


Data on the prevalence of DPN in prediabetes
among Indians are sparse. Given the burden of prediabetes and the potential
complications associated with DPN, having an estimate of the prevalence of DPN
in prediabetes and understanding the factors influencing its occurrence are
important. Hence, the objective of the present study is to estimate the
prevalence of DPN in prediabetes among Indians and to identify the main
determinants of DPN.