Impact of Diabetic Peripheral Neuropathy on Health-Related Quality of Life in Type 2 Diabetes: A Cross-Sectional EQ-5D-3L Study
Abstract
Aim: Diabetic peripheral neuropathy (DPN), a frequent microvascular complication of type 2 diabetes mellitus (T2DM), substantially compromises patients’ health-related quality of life (HRQoL). In this study, the impact of DPN on HRQoL was evaluated with the EuroQol-5D-3L (EQ-5D-3L) and Visual Analog Scale (VAS) together with an evaluation of the clinical and demographic determinants related to HRQoL.
Methods: Our study was conducted on 308 patients diagnosed with T2DM at a tertiary endocrinology clinic. DPN was evaluated through neurological examination, deep tendon reflexes, monofilament testing, and vibration perception threshold (VPT) measurements. HRQoL was evaluated with the culturally validated Turkish version of EQ-5D-3L and VAS.
Results: DPN was diagnosed in 114 patients (37.0%). Mean EQ-5D-3L index and VAS scores were lower in patients with DPN than those without (0.44 ± 0.30 vs 0.73 ± 0.20; 60.5 ± 21.6 vs 68.5 ± 19.7; p < 0.001). Pain/discomfort and anxiety/depression contributed most to reduced HRQoL. VPT values were found to be significantly and inversely correlated with EQ-5D-3L and VAS results. Subgroup analyses indicated that lower educational attainment and combined insulin–oral treatment were related to poorer HRQoL, while the presence of additional microvascular complications did not further reduce scores.
Conclusion: DPN significantly compromises HRQoL in T2DM, with pain and anxiety as dominant drivers. Objective neuropathy severity correlated with poorer perceived health, underscoring the need for early detection and comprehensive management. While the cross-sectional nature of this study exludes causal inference, the findings highlight the importance of integrating neuropathy-specific interventions into patient-centered diabetes care.
Keywords
Type 2 diabetes mellitus, Diabetic peripheral neuropathy, Health-related quality of life, EQ-5D-3L, visual analog scale
Ethical Statement
The Institutional Ethics Committee approved the study protocol (25.03.2024; approval no. 322745). All procedures were conducted in accordance with the Declaration of Helsinki, and written informed consent was obtained from all participants who agreed to take part in the study.
References
- NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. Lancet. 2024;404(10467):2077-2093.
- Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Curr Diab Rep. 2019;19(10):86.
- Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956-962.
- Smith BH, Torrance N. Epidemiology of neuropathic pain and its impact on quality of life. Curr Pain Headache Rep. 2012;16(3):191-198.
- Van Acker K, Bouhassira D, De Bacquer D, et al. Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatient clinics. Diabetes Metab. 2009;35(3):206-213.
- Dermanovic Dobrota V, Hrabac P, Skegro D, et al. The impact of neuropathic pain and other comorbidities on the quality of life in patients with diabetes. Health Qual Life Outcomes. 2014;12:171.
- Tölle T, Xu X, Sadosky AB. Painful diabetic neuropathy: a cross-sectional survey of health state impairment and treatment patterns. J Diabetes Complications. 2006;20(1):26-33.
- Gore M, Brandenburg NA, Dukes E, et al. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manage. 2005;30(4):374-385.
- EuroQol Research Foundation. EQ-5D-3L [Internet]. [Retrieved on August 8, 2025]. Available from: https://euroqol.org/information-and-support/euroqol-instruments/eq-5d-3l
- Åström M, Thet Lwin ZM, Teni FS, et al. Use of the visual analogue scale for health state valuation: a scoping review. Qual Life Res. 2023;32(10):2719-2729.