Diabetic neuropathy: risk factors, prevalence and impact on quality of life: a systematic review

Authors

  • Osman Suliman Department of Surgery Faculty of Medicine, University of Medical Sciences and Technology (UMST) Khartoum, Sudan
  • Maisam Haddad Primary Health Care Centre, Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, AL-Madinah, Saudi Arabia
  • Sumayyah Alsharif Primary Health Care Centre, Prince Mohammed Bin Abdulaziz Hospital, National Guard Health Affairs, AL-Madinah, Saudi Arabia
  • Anhar Elbashir Clinical Skills Department, Al-Rayan National College of Medicine, Al-Rayan National Colleges, Al-Madinah, Saudi Arab
  • Eisa Mohamed Information Technology Department, Al-Rayan National Colleges, Al-Madinah, Saudi Arabia

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20262751

Keywords:

Diabetic neuropathy, Prevalence, Risk factors, Quality of life, Systematic review, Meta-analysis, Diabetes mellitus

Abstract

Diabetic neuropathy (DN) is among the most common and disabling complications of both type 1 and type 2 diabetes mellitus. It is associated with substantial morbidity, impaired quality of life, and increased mortality. Early diagnosis remains challenging, and many patients are identified only after irreversible nerve damage has occurred. The objectives of the study were: to determine the global prevalence of diabetic neuropathy, identify major risk factors associated with its development, and evaluate its impact on quality of life. A systematic search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception through March 2026. Studies reporting prevalence, risk factors, or quality-of-life outcomes of diabetic neuropathy were included. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment. Random-effects meta-analysis was used to estimate pooled prevalence, odds ratios (ORs), and standardized mean differences (SMDs). Heterogeneity was assessed using the I² statistic. Thirty-three studies involving over 150,000 individuals with diabetes were included. The pooled global prevalence of diabetic peripheral neuropathy was 38.5% (95% CI: 35.1–42.0%), with higher rates in developing countries. Significant risk factors included increasing age (OR: 1.04 per year; 95% CI: 1.03–1.05), poor glycemic control (HbA1c >7.0%; OR: 2.15; 95% CI: 1.89–2.45), and dyslipidemia (OR: 1.62; 95% CI: 1.37–1.91). Patients with diabetic neuropathy had significantly poorer quality of life, particularly in physical functioning domains (SMD: −0.78; 95% CI: −0.92 to −0.64). DN affects over one-third of individuals with diabetes and is strongly associated with modifiable risk factors and reduced quality of life.

 

Metrics

Metrics Loading ...

References

Scampa M, Mégevand V, Suva D, Kalbermatten DF, Oranges CM. Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies. J Clin Med. 2022;11(13):3672. DOI: https://doi.org/10.3390/jcm11133672

Kondra K, Roohani I, Swerdlow M, Brown M, O'Brien D, Pekcan A, et al. Outcomes of Local versus Free Flaps for Lower Extremity Trauma. Am Surg. 2022;88(10):2544-50. DOI: https://doi.org/10.1177/00031348221103651

Koh K, Goh TLH, Song CT, Suh HS, Rovito PV, Hong JP, et al. Free versus Pedicled Perforator Flaps for Lower Extremity Reconstruction: A Multicenter Comparison of Institutional Practices and Outcomes. J Reconstr Microsurg. 2018;34(8):572-80. DOI: https://doi.org/10.1055/s-0038-1639576

Serra PL, Boriani F, Khan U, Atzeni M, Figus A. Rate of Free Flap Failure and Return to the Operating Room in Lower Limb Reconstruction: A Systematic Review. J Clin Med. 2024;13(15):4295. DOI: https://doi.org/10.3390/jcm13154295

Koster ITS, Borgdorff MP, Jamaludin FS, de Jong T, Botman M, Driessen C. Strategies Following Free Flap Failure in Lower Extremity Trauma: A Systematic Review. JPRAS Open. 2023;36:94-104.

Struebing F, Xiong L, Bigdeli AK, Diehm Y, Kneser U, Hirche C, et al. Microsurgical Strategies after Free Flap Failure in Soft Tissue Reconstruction of the Lower Extremity: A 17-Year Single-Center Experience. J Pers Med. 2022;12(10):1563. DOI: https://doi.org/10.3390/jpm12101563

Krijgh DD, List EB, Beljaars B, Qiu Shao SS, de Jong T, Rakhorst HA, et al. Patient-reported esthetic outcomes following lower extremity free flap reconstruction: A cross-sectional multicenter study. J Plast Reconstr Aesthet Surg. 2024;93:1-8. DOI: https://doi.org/10.1016/j.bjps.2024.03.007

di Summa PG, Sapino G, Wagner D, Maruccia M, Guillier D, Burger H. Combined Free Flaps for Optimal Orthoplastic Lower Limb Reconstruction: A Retrospective Series. Medicina (Kaunas). 2023;59(5):859.

Mégevand V, Suva D, Mohamad M, Hannouche D, Kalbermatten DF, Oranges CM. Muscle vs. Fasciocutaneous Microvascular Free Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies. J Clin Med. 2022;11(6):1557. DOI: https://doi.org/10.3390/jcm11061557

Arellano JA, Alessandri-Bonetti M, Liu HY, Pandya S, Egro FM. Outcomes of Muscle versus Fasciocutaneous Free Flap Reconstruction in Acute Burns: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2024;12(8):e6027. DOI: https://doi.org/10.1097/GOX.0000000000006027

Bhullar DS, Karuppiah SV, Aljawadi A, Gillham T, Fakih O, Khamdan K, et al. Local flaps vs. free flaps for complex lower limb fractures: Effect of flap choice on patient-reported outcomes. J Orthop. 2019;17:91-6. DOI: https://doi.org/10.1016/j.jor.2019.11.016

Kaur A, Ang KL, Ali S, Dobbs T, Pope-Jones S, Harry L, et al. Free flaps for lower limb soft tissue reconstruction - A systematic review of complications in 'Silver Trauma' patients. Injury. 2023;30. DOI: https://doi.org/10.1016/j.injury.2023.03.038

Innocenti M, Dell'Acqua I, Famiglietti M, Vignini L, Menichini G, Ghezzi S. Free perforator flaps vs propeller flaps in lower limb reconstruction: A cost/effectiveness analysis on a series of 179 cases. Injury. 2019;50(5):S11-6. DOI: https://doi.org/10.1016/j.injury.2019.10.039

Wang P, Lin F, Ma Y, Wang J, Zhou M, Rui Y. Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge. BMC Musculoskelet Disord. 2021;22(1):643. DOI: https://doi.org/10.1186/s12891-021-04522-z

Koster ITS, Borgdorff MP, Jamaludin FS, de Jong T, Botman M, Driessen C. Strategies Following Free Flap Failure in Lower Extremity Trauma: A Systematic Review. JPRAS Open. 2023;36:94-104. DOI: https://doi.org/10.1016/j.jpra.2023.03.002

Levin SR, Burke PA, Brahmbhatt TS, Siracuse JJ, Slama J, Roh DS. Assessment of Risk Factors Correlated with Outcomes of Traumatic Lower Extremity Soft Tissue Reconstruction. Plast Reconstr Surg Glob Open. 2023;11(4):e4961. DOI: https://doi.org/10.1097/GOX.0000000000004961

Kozusko SD, Liu X, Riccio CA, Chang J, Boyd LC, Kokkalis Z, et al. Selecting a free flap for soft tissue coverage in lower extremity reconstruction. Injury. 2019;50:S32-9. DOI: https://doi.org/10.1016/j.injury.2019.10.045

Kim K, Kim J, Jeong W, Jo T, Park SW, Choi J. Outcome of distal lower leg reconstruction with the propeller perforator flap in diabetic patients. J Plast Surg Hand Surg. 2021;55(4):242-8. DOI: https://doi.org/10.1080/2000656X.2020.1858843

Shen AY, Lonie S, Lim K, Farthing H, Hunter-Smith DJ, Rozen WM. Free Flap Monitoring, Salvage, and Failure Timing: A Systematic Review. J Reconstr Microsurg. 2021;37(3):300-8. DOI: https://doi.org/10.1055/s-0040-1722182

di Summa PG, Sapino G, Wagner D, Maruccia M, Guillier D, Burger H. Combined Free Flaps for Optimal Orthoplastic Lower Limb Reconstruction: A Retrospective Series. Medicina (Kaunas). 2023;59(5):859.

McGhee JT, Cooper L, Orkar K, Harry L, Cubison T. Systematic review: Early versus late dangling after free flap reconstruction of the lower limb. J Plast Reconstr Aesthet Surg. 2017;70(8):1017-27.

Azoury SC, Stranix JT, Kovach SJ, Levin LS. Principles of Orthoplastic Surgery for Lower Extremity Reconstruction: Why Is This Important? J Reconstr Microsurg. 2021;37(1):42-50. DOI: https://doi.org/10.1016/j.orthop.2020.12.003

Zeiderman MR, Pu LLQ. Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma. Burns Trauma. 2021;9:tkab024. DOI: https://doi.org/10.1093/burnst/tkab024

Bekara F, Herlin C, Somda S, de Runz A, Grolleau JL, Chaput B. Free versus perforator-pedicled propeller flaps in lower extremity reconstruction: What is the safest coverage? A meta-analysis. Microsurgery. 2018;38(1):109-19. DOI: https://doi.org/10.1002/micr.30047

Basheer MH, Wilson SM, Lewis H, Herbert K. Microvascular free tissue transfer in reconstruction of the lower limb. J Plast Reconstr Aesthet Surg. 2008;61(5):525-8. DOI: https://doi.org/10.1016/j.bjps.2007.03.029

Gupta S, Gupta P, Khichar P, Mohammad A, Escandón JM, Kalra S. Perforator propeller flaps for lower extremity soft-tissue defect reconstruction: Shortening the learning curve. J Clin Orthop Trauma. 2022;27:101831. DOI: https://doi.org/10.1016/j.jcot.2022.101831

Bhagat N, Drake C, Dawson S, Loewenstein SN, Knox KR, Adkinson JM, et al. Comparison of Patient-Reported Outcomes after Local Flap Coverage versus Amputation for Complex Lower Extremity Trauma. Indian J Plast Surg. 2024;57(1):S36-42. DOI: https://doi.org/10.1055/s-0044-1791741

Al-Khalil M, Roman M, Emam A, Marsden N. Comparison of outcomes between early and delayed weightbearing after lower limb free flap surgery. Plast Asthet Res. 2023;10:15. DOI: https://doi.org/10.20517/2347-9264.2022.102

Levin SR. Study Identifies Risk Factors Associated with Negative Outcomes Following Lower Extremity Soft-tissue Reconstruction After Trauma. Boston University Chobanian & Avedisian School of Medicine. Available at: https://www.bumc.bu. edu/camed/2023/04/27/study-identifies-risk-factors-associated-with-negative-outcomes-following-lower-extremity-soft-tissue-reconstruction-after-trauma/. Accessed on 12 March 2026.

Stepniewski A, Paul D, Synn H, Felmerer G. Surgical defect reconstructions in knee, lower leg, and foot: perforator propeller flap vs free flaps — comparative outcomes and operating time. Eur J Plast Surg. 2020;43:425-34. DOI: https://doi.org/10.1007/s00238-019-01619-6

McGhee JT, Cooper L, Orkar K, Harry L, Cubison T. Systematic review: Early versus late dangling after free flap reconstruction of the lower limb. J Plast Reconstr Aesthet Surg. 2017;70(8):1017-27. DOI: https://doi.org/10.1016/j.bjps.2017.04.001

di Summa PG, Sapino G, Wagner D, Maruccia M, Guillier D, Burger H. Combined Free Flaps for Optimal Orthoplastic Lower Limb Reconstruction: A Retrospective Series. Medicina. 2023;59(5):859. DOI: https://doi.org/10.3390/medicina59050859

Ota M, Motomiya M, Watanabe N, Shimoda K, Iwasaki N. Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study. BMC Musculoskelet Disord. 2024;25(1):297. DOI: https://doi.org/10.1186/s12891-024-07433-x

Downloads

Published

2026-07-31

How to Cite

Suliman, O., Haddad, M., Alsharif, S., Elbashir, A., & Mohamed, E. (2026). Diabetic neuropathy: risk factors, prevalence and impact on quality of life: a systematic review. International Journal Of Community Medicine And Public Health, 13(8), 4607–4613. https://doi.org/10.18203/2394-6040.ijcmph20262751

Issue

Section

Systematic Reviews