Women more likely to have pain with diabetic peripheral neuropathy

Cardiometabolic factors traditionally associated with microvascular disease were not associated with risk for painful diabetic peripheral neuropathy in patients with type 1 diabetes, a European study found.

Female sex was a risk factor for painful diabetic peripheral neuropathy (DPN), and there is less evidence of cardiovascular factors in painful cases compared with painless cases, a study found.

Researchers analyzed the EURODIAB Prospective Complications Study to examine the incidence and risk factors of painful DPN. They recruited 3,250 participants with type 1 diabetes and followed them for a mean of 7.3 years via clinical assessment, quantitative sensory testing, and autonomic function tests. Painful DPN, defined as painful neuropathic symptoms in the legs, was assessed at baseline and follow-up. Results were published Oct. 23 in Diabetologia.

At baseline, 234 (25.2%) out of 927 participants with DPN had painful DPN. At follow-up, an additional 276 patients had developed incident DPN (23.5% of 1,172 participants without the condition at baseline). Of these, 41 (14.9%) had incident painful DPN. There were no significant differences in clinical and demographic variables, including age, body mass index, HbA1c level, lipid profile, and blood pressure, between patients with painless and painful DPN.

Most of the participants who developed incident painful DPN versus painless DPN were female (73% vs. 48%; P=0.003). The sex difference remained significant after adjustment for duration of diabetes and HbA1c level (odds ratio for women vs. men, 2.69 [95% CI, 1.41 to 6.23]; P=0.004). The proportion of participants with macro- or microalbuminuria was lower in those with painful DPN compared with painless DPN (15% vs. 34%; P=0.02). This association remained after adjustment for HbA1c level, diabetes duration, and sex (P=0.03).

Painful DPN was not driven by cardiometabolic factors traditionally associated with microvascular disease, the study authors said. They called the association between female sex and DPN “striking” and suggested that painful DPN may not be driven by simple cardiometabolic factors but may be influenced by psychological, social, cultural, genetic, and other factors. “The findings of this study will provide greater awareness that female patients are at risk of developing painful DPN in clinical practice,” they wrote.