Unmet Needs in Diabetic Distal Symmetric Polyneuropathy: A Cross-sectional Analysis from a Tertiary Care Diabetes Centre in Sri Lanka

Background: Distal symmetric polyneuropathy (DSPN) is the commonest type of neuropathy among people living with diabetes. We aimed to describe the clinical manifestations, foot complications, quality of life and self-care practices among adults with diabetic DSPN.
Methods: We conducted a cross-sectional study in the Diabetes Clinic of National Hospital Colombo, Sri Lanka in 2022. Adults with diabetes and symptoms and/or signs of DSPN were recruited by consecutive sampling at Annual Diabetes End-organ Screening. Demographic and clinical data were collected via patient interviews and review of medical records. Quality of life (QoL) was determined using the SF-36 questionnaire.
Results: Among 201 patients with diabetic DSPN (mean age 61 years [SD 10], men 39%, median duration of diabetes 15 years [IQR 8-25], loss of protective sensation in 99%), 65% had one or more DSPN-related foot complications (deformity 12%, pre-ulcer 59%, past or present ulcer 13%, lower limb amputation 5%). Peripheral arterial disease (B=1.88, SE=0.67, p=0.005) and body mass index (B=0.1, SE=0.05, p=0,027) were independent predictors DSPN-related foot complications. 129 (64%) reported burning pain in feet. Among them, only 27% received pharmacological treatment and amongst those treated, only 24% achieved symptom relief. QoL scores were lowest in physical function (45 [IQR 30-80]) and bodily pain (63 [IQR 45-78]) domains and scores were lower among those with burning pain, compared to those without. Self-care practices were suboptimal (daily foot inspection 78%, footwear both indoors and outdoors 36%, use of diabetic footwear 7%).
Conclusion: Among Sri Lankan adults living with diabetes and DSPN, 65% had one or more foot complications while 64% had burning pain in feet, which was not treated or inadequately treated in the majority. DSPN was associated with reduced QoL score. Foot-related self-care practices remain suboptimal even amongst those with DSPN and foot complications.