Association of glycaemic control with peripheral neuropathy severity among patients with type 2 diabetes mellitus: A cross-sectional observational study.

Dr. Rajesh  Donagiri; Dr. Manoj Sai  Kuchi; Dr. Bandi  Indu

doi:10.51168/sjhrafrica.v7i2.2786

Authors

Dr. Rajesh Donagiri Assistant Professor, Department of General Medicine, Government Medical College and General Hospital, Nizamabad, Telangana, India
Dr. Manoj Sai Kuchi Assistant Professor, Department of General Medicine, Government Medical College and General Hospital, Nizamabad, Telangana, India
Dr. Bandi Indu Assistant Professor, Department of Obstetrics and Gynaecology, Government Medical College and General Hospital, Nizamabad, Telangana, India

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2786

Keywords:

Type 2 diabetes mellitus, Glycaemic control, HbA1c, Diabetic peripheral neuropathy, Neuropathy severity

Abstract

Background:

To assess the association between glycaemic control and peripheral neuropathy severity among patients with type 2 diabetes mellitus.

Methods:

This hospital-based cross-sectional observational study was conducted in the Department of General Medicine, Government Medical College/Government General Hospital, Nizamabad, Telangana, India, from March to August 2025. A total of 100 eligible patients with type 2 diabetes mellitus were included and analysed. Demographic and clinical variables, fasting blood glucose, postprandial blood glucose, and HbA1c were recorded. Glycaemic control was classified as good (<7.0%), suboptimal (7.0-8.9%), or poor (≥9.0%). Peripheral neuropathy was clinically graded as absent, mild, moderate, or severe. Associations were evaluated using the chi-square test, and correlation analysis assessed the relationship between HbA1c and neuropathy severity.

Results:

The mean age was 52.6 ± 10.8 years, and the mean diabetes duration was 8.7 ± 5.1 years. Good, suboptimal, and poor glycaemic control occurred in 28 (28.0%), 38 (38.0%), and 34 (34.0%) patients, respectively. Peripheral neuropathy was present in 77 (77.0%); 32 (32.0%) had mild, 33 (33.0%) moderate, and 12 (12.0%) severe neuropathy. Neuropathy severity differed significantly across HbA1c categories (χ²=26.93, p<0.001). Moderate-to-severe neuropathy was more frequent in patients with HbA1c ≥9.0% than in those with HbA1c <9.0% (70.6% versus 31.8%; χ²=13.63, p<0.001). Mean HbA1c increased from 6.9 ± 0.8% in patients without neuropathy to 10.1 ± 1.1% in those with severe neuropathy (p<0.001), and HbA1c correlated positively with neuropathy severity (r=0.58, p<0.001).

Conclusion:

Poor glycaemic control was significantly associated with greater peripheral neuropathy severity. Higher HbA1c and longer diabetes duration identified patients with an increased neuropathy burden.

Author Biographies

Dr. Rajesh Donagiri, Assistant Professor, Department of General Medicine, Government Medical College and General Hospital, Nizamabad, Telangana, India

is an Assistant Professor in the Department of General Medicine, Government General Hospital, Nizamabad, Telangana, India. He is actively involved in undergraduate and postgraduate medical teaching, clinical patient care, and academic activities in internal medicine. His areas of professional interest include general medical disorders, Neurological disorders, chronic disease management, emergency care, and hospital-based clinical research.

Dr. Manoj Sai Kuchi, Assistant Professor, Department of General Medicine, Government Medical College and General Hospital, Nizamabad, Telangana, India

is an Assistant Professor in the Department of General Medicine, Government General Hospital, Nizamabad, Telangana, India. He contributes to undergraduate and postgraduate medical teaching, inpatient and outpatient medical services, and departmental academic work. His professional interests include internal medicine, preventive healthcare, clinical case evaluation, and research related to common medical conditions seen in tertiary care practice.ORCID iD: https://orcid.org/0009-0005-6188-2590

Dr. Bandi Indu, Assistant Professor, Department of Obstetrics and Gynaecology, Government Medical College and General Hospital, Nizamabad, Telangana, India

is an Assistant Professor in the Department of Obstetrics and Gynaecology, Government General Hospital, Nizamabad, Telangana, India. She is engaged in undergraduate and postgraduate teaching, obstetric and gynaecological clinical care, and academic activities. Her areas of interest include maternal health, high-risk pregnancy care, reproductive health, women’s health, and clinical research in obstetrics and gynaecology.

References

American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49(Suppl 1):S261-S276. https://doi.org/10.2337/dc26-S012

Pop-Busui R, Boulton AJM, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-154. https://doi.org/10.2337/dc16-2042

Tesfaye S, Boulton AJM, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285-2293. https://doi.org/10.2337/dc10-1303

Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Curr Diab Rep. 2019;19(10):86. https://doi.org/10.1007/s11892-019-1212-8

Sun J, Wang Y, Zhang X, Zhu S, He H. Prevalence of peripheral neuropathy in patients with diabetes: A systematic review and meta-analysis. Prim Care Diabetes. 2020;14(5):435-444. https://doi.org/10.1016/j.pcd.2019.12.005

Pradeepa R, Rema M, Vignesh J, Deepa M, Deepa R, Mohan V. Prevalence and risk factors for diabetic neuropathy in an urban south Indian population: the Chennai Urban Rural Epidemiology Study (CURES-55). Diabet Med. 2008;25(4):407-412. https://doi.org/10.1111/j.1464-5491.2008.02397.x

Bansal D, Gudala K, Muthyala H, Esam HP, Nayakallu R, Bhansali A. Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting. J Diabetes Investig. 2014;5(6):714-721. https://doi.org/10.1111/jdi.12223

Darivemula S, Nagoor K, Patan SK, Reddy NB, Deepthi CS, Chittooru CS. Prevalence and its associated determinants of diabetic peripheral neuropathy in individuals having type 2 diabetes mellitus in rural South India. Indian J Community Med. 2019;44(2):88-91. https://doi.org/10.4103/ijcm.IJCM_207_18

Gill HK, Yadav SB, Ramesh V, Bhatia E. A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type 2 diabetes mellitus. J Postgrad Med. 2014;60(3):270-275. https://doi.org/10.4103/0022-3859.138750

Yagihashi S, Mizukami H, Sugimoto K. Mechanism of diabetic neuropathy: where are we now and where to go? J Diabetes Investig. 2011;2(1):18-32. https://doi.org/10.1111/j.2040-1124.2010.00070.x

Nozawa K, Ikeda M, Kikuchi S. Association between HbA1c levels and diabetic peripheral neuropathy: a case-control study of patients with type 2 diabetes using claims data. Drugs Real World Outcomes. 2022;9(3):403-414. https://doi.org/10.1007/s40801-022-00309-3

Su JB, Zhao LH, Zhang XL, Cai HL, Huang HY, Xu F, et al. HbA1c variability and diabetic peripheral neuropathy in type 2 diabetic patients. Cardiovasc Diabetol. 2018;17(1):47. https://doi.org/10.1186/s12933-018-0693-0

Lai YR, Chiu WC, Huang CC, Tsai NW, Wang HC, Lin WC, et al. HbA1c variability is strongly associated with the severity of peripheral neuropathy in patients with type 2 diabetes. Front Neurosci. 2019;13:90. https://doi.org/10.3389/fnins.2019.00090

Callaghan BC, Little AA, Feldman EL, Hughes RAC. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev. 2012;(6): CD007543. https://doi.org/10.1002/14651858.CD007543.pub2