{"paper_id":"3bbf4031-b484-47f2-b0db-edfd46066de8","body_text":"The Prevalence of Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes Attending an Urban Health Centre | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Prevalence of Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes Attending an Urban Health Centre Michael Selvaraj Albert, MANOJ ABRAHAM MANOHARLAL, FRANKLIN SHAJU M This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7481785/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Diabetic neuropathy is among the most prevalent complications of diabetes, affecting up to half of patients. Diabetic peripheral neuropathy (DPN), the most frequent form, predominantly involves the lower limbs and hands. Loss of protective sensation increases the risk of chronic injury, ulceration, and amputation. Since many cases of DPN remain asymptomatic, routine screening is vital for early detection and management. Objectives: To determine the prevalence of DPN among patients with type 2 diabetes attending a rural health centre in Ooty, Tamil Nadu, and to examine associations with body mass index (BMI), physical activity, glycaemic control, smoking, alcohol intake, and sociodemographic variables. Methods: A cross-sectional study was conducted among 156 patients with type 2 diabetes at an urban health centre. The Michigan Neuropathy Screening Instrument (MNSI), which includes a structured symptom questionnaire and physical examination, was used to identify neuropathy. Sociodemographic and clinical data were collected, and associations were analyzed statistically. Results: Of the participants, 66.6% were male and 33.3% were female, with a mean age of 50.8 years (SD = 12.3). The mean duration of diabetes was 8.3 years (SD = 5.5). Prevalence of DPN was 16.5% by questionnaire and 21.8% by examination. DPN was significantly associated with older age (≥60 years; p < 0.001, OR = 3.98) and longer duration of diabetes (≥5 years; p = 0.003, OR = 6.01). Conclusion: A substantial proportion of patients with type 2 diabetes had unrecognized DPN. Older age and longer disease duration were key correlates. Incorporating validated screening tools such as the MNSI into routine care in primary health centres may facilitate earlier detection and timely management of DPN. Diabetic peripheral neuropathy Michigan Neuropathy Screening Instrument prevalence risk factors Introduction Diabetes mellitus is a growing global health challenge, with an estimated 463 million individuals currently affected worldwide. Within Southeast Asia, India contributes substantially, accounting for nearly 77 million of the 88 million cases reported in the region¹. Among the chronic complications of diabetes, diabetic neuropathy (DN) is one of the most prevalent, affecting over half of patients during their lifetime². DN comprises a spectrum of clinical syndromes, including autonomic neuropathy, radiculopathy, polyradiculopathy, and distal symmetric polyneuropathy (DSPN)². Compared with many other chronic diseases, diabetes is associated with a disproportionately higher burden of morbidity, disability, premature mortality, and healthcare costs³. Diabetic peripheral neuropathy (DPN), a common microvascular complication, is of particular clinical relevance⁴. DSPN is typically diagnosed in the presence of characteristic signs and symptoms of peripheral nerve involvement, once alternative causes of neuropathy have been excluded. The reported prevalence of DPN varies widely: approximately 20% among patients without type 1 diabetes, 10–15% in those newly diagnosed with type 2 diabetes, and nearly 50% in individuals with a disease duration of 10 years or more. Evidence from India similarly indicates a prevalence ranging between 18% and 51%⁵. In light of this variability, the present study was undertaken to determine the prevalence of DPN among individuals with type 2 diabetes attending an urban health centre in Ooty, Tamil Nadu. Additionally, the study explored associations between neuropathy and sociodemographic characteristics, duration of diabetes, treatment modality, body mass index (BMI), smoking, and alcohol consumption. Objectives To screen individuals with type 2 diabetes attending the Ooty Urban Health Centre, Tamilnadu, for diabetic peripheral neuropathy (DPN) using the Michigan Neuropathy Screening Instrument (MNSI). To evaluate the relationship between DPN and sociodemographic factors, body mass index (BMI), physical activity, glycaemic control, smoking, alcohol use, and duration of diabetes. Need for the Study Diabetic peripheral neuropathy (DPN) is among the most common and disabling complications of diabetes, contributing substantially to impaired quality of life, higher healthcare costs, and increased risk of foot ulcers and lower limb amputations⁴. Early detection of individuals at risk within primary care and community settings is vital to reduce long-term morbidity and disability. Despite its clinical importance, there is limited evidence on the prevalence and determinants of DPN in semi-urban and urban primary care populations in Tamilnadu. This study seeks to address this gap by estimating the prevalence of DPN and examining its associations with relevant demographic, clinical, and lifestyle factors in an urban cohort. Materials and Methods A cross-sectional study was conducted at the Urban Health Centre, Ooty, Tamil Nadu, for a duration of two months. The required sample size was calculated considering a prevalence of 32%, a 95% confidence level, and 20% relative precision, which yielded a minimum of 156 participants. Accordingly, 156 individuals with type 2 diabetes mellitus visiting the outpatient clinic were enrolled, including both newly diagnosed and previously known cases. Eligibility criteria included all adults with type 2 diabetes regardless of disease duration, while patients with other potential causes of neuropathy such as chronic alcoholism, vitamin B12 deficiency, or chronic kidney disease were excluded. Patients unwilling to give consent were also not considered. Screening for peripheral neuropathy was carried out using the Michigan Neuropathy Screening Instrument (MNSI). This tool has two parts: a history section with 15 symptom-related questions (covering numbness, tingling, burning pain, altered temperature sensation, skin dryness, and history of ulcers or amputation), where a score of ≥ 4 suggests neuropathy; and an examination section involving foot inspection for ulcers or infections, assessment of ankle reflexes, vibration sense, and 10-g monofilament testing, where a score of ≥ 2 indicates neuropathy. The study received approval from the Institutional Ethics Committee of KG College of Physiotherapy, Coimbatore, affiliated with The Tamil Nadu Dr. M.G.R. Medical University, Chennai. Written informed consent was obtained from all participants before inclusion. Results Sociodemographic Characteristics Among the 156 study participants, two-thirds were men (66.6%) and one-third were women (33.3%). The mean age of the sample was 50.8 ± 12.3 years, while the mean duration of diabetes was 8.3 ± 5.5 years (Table 1 ). Table 1 THE SOCIODEMOGRAPHIC DETAILS OF THE PARTICIPANTS Characteristics Frequency Percentage Age (mean = 50.86 ± 12.26) 21–30 8 5.1% 31–40 21 13.4% 41–50 40 25.6% 51–60 50 32% Above 60 37 23.7% Sex Male 104 66.6% Female 52 33.3% Education Literate 102 65.3% Illiterate 54 34.6% Employment status Employed 124 79.4% Un employed 32 20.5% Socioeconomic status Upper class 39 25% Middle class 94 60.2% Lower class 23 14.7% Marital status Married 135 86.5% Unmarried 15 9.6% Widow/divorced /separated 6 3.8% Prevalence of Diabetic Peripheral Neuropathy (DPN) Screening with the MNSI questionnaire indicated that 16.5% of participants were positive for neuropathic symptoms, while clinical examination using the MNSI identified neuropathy in 21.8% of individuals. Factors Associated with DPN Older age (≥ 60 years) was significantly related to the presence of neuropathy (OR = 3.98, p < 0.001). Duration of diabetes of five years or more showed a strong association with neuropathy (OR = 6.01, p = 0.003). Lifestyle and clinical variables such as smoking, alcohol consumption, obesity, and insulin use also demonstrated positive correlations with neuropathy (Table 2 ). Table 2 ASSOCIATION BETWEEN SELECTED VARIABLES AND DIABETIC PERIPHERAL NEUROPATHY Characteristics n MNSI + ve % Odds ratio 95% CI P DURATION OF DIABETES (mean = 8.32 ± 5.5) Above 10 years 36 24 66.6% 26.333 14.1651–48.95 < 0.0001 6–10 years 68 17 25% 9.7042 5.3218–17.695 < 0.0001 5 years and above 52 2 3.8% 154.96 36.93–650.20 < 0.0001 H/O SMOKING Present 23 14 60.8% 58.39 28.83-118.25 < 0.0001 Absent 133 31 23.3% 0.306 0.136–0.689 = 0.0043 H/O ALCOHOL CONSUMPTION Present 29 14 48.2% 43.97 22.23–86.97 < 0.0001 Absent 127 31 24.4% 0.042 0.0057–0.313 = 0.0020 BMI Normal and underweight 86 14 16.2% 7.348 3.86–13.96 < 0.0001 Overweight 67 27 40.2% 5.415 3.172-9.243-9.243 < 0.0001 Obese 03 2 66.6% 3976.3 655.26-24129.5 < 0.0001 MODALITY OF TREATMENT OHA 121 32 26.4% 38.79 19.78–76.08 < 0.0001 Insulin/insulin + OHA 35 13 37.1% 36.461 18.47–71.95 < 0.0001 Discussion In this study, the prevalence of diabetic peripheral neuropathy (DPN) was observed to be 16.5% based on the MNSI questionnaire and 21.8% using the MNSI examination. These results are in line with those reported by D’Souza et al., who documented prevalence rates of 18.3% and 32.2% with the respective MNSI components.⁶ Similarly, Al Kaabi et al. identified prevalence rates of 10.4% and 25.6% in a UAE population.⁷ Reports from other Indian cohorts have demonstrated considerably higher prevalence, ranging between 47% in the study by George et al. and 51.8% in the study by Vibha et al.⁵˒⁸ The observed variation across studies may reflect differences in study populations, screening tools, diagnostic definitions, and duration of diabetes. Furthermore, the gap between questionnaire-based and examination-based prevalence underlines the greater sensitivity of clinical assessment, as symptom-based reporting alone may fail to capture subclinical or early-stage neuropathy. Consistent with prior literature, the present analysis identified older age (≥ 60 years) and a longer duration of diabetes (> 5 years) as significant predictors of DPN.⁹–¹¹ These associations can be explained by age-related degenerative changes, vascular insufficiency, and cumulative exposure to chronic hyperglycaemia, all of which contribute to progressive nerve damage. Lifestyle-related factors, including smoking and alcohol intake, were also positively associated with neuropathy, which corroborates evidence from previous investigations. The findings highlight the “iceberg phenomenon” of DPN, wherein a substantial proportion of individuals may remain asymptomatic until later stages. This emphasizes the importance of systematic neuropathy screening in primary care, particularly for elderly patients and those with long-standing diabetes, to enable early detection and timely intervention. Conclusion This study demonstrates that diabetic peripheral neuropathy remains a significant complication among individuals with type 2 diabetes, with prevalence rates of 16.5% and 21.8% identified through the MNSI questionnaire and examination, respectively. The findings confirm that advancing age, longer disease duration, and lifestyle factors such as smoking and alcohol consumption are key determinants of neuropathy risk. The disparity between questionnaire- and examination-based outcomes further highlights the limitations of symptom-based reporting and underscores the necessity of clinical evaluation for accurate detection. Given the high burden and asymptomatic nature of early neuropathy, routine screening at the primary care level should be prioritized, particularly in elderly patients and those with diabetes of more than five years’ duration. Early identification and timely intervention could mitigate complications, improve quality of life, and reduce the long-term healthcare burden. Declarations Ethics Approval and Consent to Participate Ethical clearance was obtained from the Ethics Committee, KG College of Physiotherapy, and Coimbatore. Written informed consent was obtained from all participants. Competing Interests The authors declare no competing interests. Funding This research received no external funding and was self-financed by the primary author. Author Contribution Authors’ ContributionsConcept & Design: Michael SelvarajSupervision: Manoj AbrahamData Collection & Processing: Michael SelvarajAnalysis & Interpretation: Michael Selvaraj, Franklin shajuLiterature Review: Michael Selvaraj,Manuscript Writing: Michael SelvarajCritical Review: Michael Selvaraj, Manoj Abraham,Franklin ShajuFunding & References: Michael Selvaraj Acknowledgements None. References Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5:41. Pop-Busui R, Boulton AJ, 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):136–54. Bommer C, Sagalova V, Heesemann E, Manne-Goehler J, Atun R, Bärnighausen T, et al. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care. 2018;41(5):963–70. 10.2337/dc17-1962 . Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol. 2012;11(6):521–34. 10.1016/S1474-4422(12)70065-0 . Kamalarathnam SR, Varadarajan S. Diabetic peripheral neuropathy among diabetic patients in an urban health and training centre. J Family Med Prim Care. 2022;11(1):113–7. D’Souza M, Kulkarni V, Bhaskaran U, Ahmed H, Naimish H, Prakash A, et al. Determinants of diabetic peripheral neuropathy among patients in a tertiary health centre in Mangalore, India. J Public Health Res. 2015;4:450. Al-Maskari F, El-Sadig M, Al-Kaabi JM, Afandi B, Nagelkerke N, Yeatts KB. Knowledge, attitudes, and practices of diabetic patients in the United Arab Emirates. PLoS ONE. 2013;8(1):e52857. George H, Rakesh P, Krishna M, Alex R, Abraham VJ, George K, et al. Foot care knowledge, practices, and prevalence of peripheral neuropathy among people with diabetes in a rural secondary hospital, South India. J Family Med Prim Care. 2013;2(1):27–32. Gill HK, Yadav SB, Ramesh V, Bhatia E. Prevalence and association of peripheral neuropathy in newly diagnosed type 2 diabetes patients: a prospective study from India. J Postgrad Med. 2014;60(3):270–5. Bansal D, Gudala K, Muthyala H, Esam HP, Nayakallu R, Bhansali A. Risk factors for development of peripheral diabetic neuropathy in type 2 diabetes: a tertiary care study. J Diabetes Investig. 2014;5(6):714–21. Belmin J, Valensi P. Diabetic neuropathy in elderly patients: therapeutic perspectives. Drugs Aging. 1996;8(5):416–29. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Within Southeast Asia, India contributes substantially, accounting for nearly 77\\u0026nbsp;million of the 88\\u0026nbsp;million cases reported in the region\\u0026sup1;. Among the chronic complications of diabetes, diabetic neuropathy (DN) is one of the most prevalent, affecting over half of patients during their lifetime\\u0026sup2;. DN comprises a spectrum of clinical syndromes, including autonomic neuropathy, radiculopathy, polyradiculopathy, and distal symmetric polyneuropathy (DSPN)\\u0026sup2;.\\u003c/p\\u003e\\u003cp\\u003eCompared with many other chronic diseases, diabetes is associated with a disproportionately higher burden of morbidity, disability, premature mortality, and healthcare costs\\u0026sup3;. Diabetic peripheral neuropathy (DPN), a common microvascular complication, is of particular clinical relevance⁴. DSPN is typically diagnosed in the presence of characteristic signs and symptoms of peripheral nerve involvement, once alternative causes of neuropathy have been excluded. The reported prevalence of DPN varies widely: approximately 20% among patients without type 1 diabetes, 10\\u0026ndash;15% in those newly diagnosed with type 2 diabetes, and nearly 50% in individuals with a disease duration of 10 years or more. Evidence from India similarly indicates a prevalence ranging between 18% and 51%⁵.\\u003c/p\\u003e\\u003cp\\u003eIn light of this variability, the present study was undertaken to determine the prevalence of DPN among individuals with type 2 diabetes attending an urban health centre in Ooty, Tamil Nadu. Additionally, the study explored associations between neuropathy and sociodemographic characteristics, duration of diabetes, treatment modality, body mass index (BMI), smoking, and alcohol consumption.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eObjectives\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003col\\u003e\\u003cspan\\u003e\\u003cli\\u003e\\u003cp\\u003eTo screen individuals with type 2 diabetes attending the Ooty Urban Health Centre, Tamilnadu, for diabetic peripheral neuropathy (DPN) using the Michigan Neuropathy Screening Instrument (MNSI).\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/span\\u003e\\u003cspan\\u003e\\u003cli\\u003e\\u003cp\\u003eTo evaluate the relationship between DPN and sociodemographic factors, body mass index (BMI), physical activity, glycaemic control, smoking, alcohol use, and duration of diabetes.\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/span\\u003e\\u003c/ol\\u003e\\u003c/p\\u003e\\n\\u003ch3\\u003eNeed for the Study\\u003c/h3\\u003e\\n\\u003cp\\u003eDiabetic peripheral neuropathy (DPN) is among the most common and disabling complications of diabetes, contributing substantially to impaired quality of life, higher healthcare costs, and increased risk of foot ulcers and lower limb amputations⁴. Early detection of individuals at risk within primary care and community settings is vital to reduce long-term morbidity and disability. Despite its clinical importance, there is limited evidence on the prevalence and determinants of DPN in semi-urban and urban primary care populations in Tamilnadu. This study seeks to address this gap by estimating the prevalence of DPN and examining its associations with relevant demographic, clinical, and lifestyle factors in an urban cohort.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003eA cross-sectional study was conducted at the Urban Health Centre, Ooty, Tamil Nadu, for a duration of two months. The required sample size was calculated considering a prevalence of 32%, a 95% confidence level, and 20% relative precision, which yielded a minimum of 156 participants. Accordingly, 156 individuals with type 2 diabetes mellitus visiting the outpatient clinic were enrolled, including both newly diagnosed and previously known cases. Eligibility criteria included all adults with type 2 diabetes regardless of disease duration, while patients with other potential causes of neuropathy such as chronic alcoholism, vitamin B12 deficiency, or chronic kidney disease were excluded. Patients unwilling to give consent were also not considered.\\u003c/p\\u003e\\u003cp\\u003eScreening for peripheral neuropathy was carried out using the Michigan Neuropathy Screening Instrument (MNSI). This tool has two parts: a history section with 15 symptom-related questions (covering numbness, tingling, burning pain, altered temperature sensation, skin dryness, and history of ulcers or amputation), where a score of \\u0026ge;\\u0026thinsp;4 suggests neuropathy; and an examination section involving foot inspection for ulcers or infections, assessment of ankle reflexes, vibration sense, and 10-g monofilament testing, where a score of \\u0026ge;\\u0026thinsp;2 indicates neuropathy.\\u003c/p\\u003e\\u003cp\\u003e The study received approval from the Institutional Ethics Committee of KG College of Physiotherapy, Coimbatore, affiliated with The Tamil Nadu Dr. M.G.R. Medical University, Chennai. Written informed consent was obtained from all participants before inclusion.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eSociodemographic Characteristics\\u003c/h2\\u003e\\u003cp\\u003eAmong the 156 study participants, two-thirds were men (66.6%) and one-third were women (33.3%). The mean age of the sample was 50.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.3 years, while the mean duration of diabetes was 8.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.5 years (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eTHE SOCIODEMOGRAPHIC DETAILS OF THE PARTICIPANTS\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"3\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCharacteristics\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eFrequency\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003ePercentage\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eAge (mean\\u0026thinsp;=\\u0026thinsp;50.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.26)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e21\\u0026ndash;30\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e5.1%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e31\\u0026ndash;40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.4%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e41\\u0026ndash;50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e40\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25.6%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e51\\u0026ndash;60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e32%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAbove 60\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e37\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e23.7%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSex\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e104\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e66.6%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e52\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e33.3%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eEducation\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLiterate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e102\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e65.3%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eIlliterate\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e54\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e34.6%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eEmployment status\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEmployed\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e124\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e79.4%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eUn employed\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e20.5%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eSocioeconomic status\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eUpper class\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e39\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMiddle class\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e94\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e60.2%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLower class\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e23\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14.7%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c3\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMarital status\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMarried\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e135\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e86.5%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eUnmarried\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e9.6%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWidow/divorced /separated\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3.8%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003ePrevalence of Diabetic Peripheral Neuropathy (DPN)\\u003c/h3\\u003e\\n\\u003cp\\u003eScreening with the MNSI questionnaire indicated that 16.5% of participants were positive for neuropathic symptoms, while clinical examination using the MNSI identified neuropathy in 21.8% of individuals.\\u003c/p\\u003e\\n\\u003ch3\\u003eFactors Associated with DPN\\u003c/h3\\u003e\\n\\u003cp\\u003eOlder age (\\u0026ge;\\u0026thinsp;60 years) was significantly related to the presence of neuropathy (OR\\u0026thinsp;=\\u0026thinsp;3.98, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Duration of diabetes of five years or more showed a strong association with neuropathy (OR\\u0026thinsp;=\\u0026thinsp;6.01, p\\u0026thinsp;=\\u0026thinsp;0.003). Lifestyle and clinical variables such as smoking, alcohol consumption, obesity, and insulin use also demonstrated positive correlations with neuropathy (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eASSOCIATION BETWEEN SELECTED VARIABLES AND DIABETIC PERIPHERAL NEUROPATHY\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"7\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCharacteristics\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003en\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eMNSI\\u0026thinsp;+\\u0026thinsp;ve\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e%\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003eOdds ratio\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e95% CI\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003eP\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c7\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003eDURATION OF DIABETES (mean\\u0026thinsp;=\\u0026thinsp;8.32\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.5)\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAbove 10 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e36\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e66.6%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e26.333\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e14.1651\\u0026ndash;48.95\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e6\\u0026ndash;10 years\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e68\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e17\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e25%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e9.7042\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e5.3218\\u0026ndash;17.695\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e5 years and above\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e52\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e3.8%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e154.96\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e36.93\\u0026ndash;650.20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c7\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eH/O SMOKING\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePresent\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e23\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e60.8%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e58.39\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e28.83-118.25\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAbsent\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e133\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e31\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e23.3%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.306\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.136\\u0026ndash;0.689\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e=\\u0026thinsp;0.0043\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c7\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eH/O ALCOHOL CONSUMPTION\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePresent\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e29\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e48.2%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e43.97\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e22.23\\u0026ndash;86.97\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAbsent\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e127\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e31\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e24.4%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0.042\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0.0057\\u0026ndash;0.313\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e=\\u0026thinsp;0.0020\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eBMI\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNormal and underweight\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e86\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e14\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e16.2%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e7.348\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e3.86\\u0026ndash;13.96\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOverweight\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e67\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e40.2%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e5.415\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e3.172-9.243-9.243\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eObese\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e03\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e66.6%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e3976.3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e655.26-24129.5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c7\\\" namest=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eMODALITY OF TREATMENT\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOHA\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e121\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e32\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e26.4%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e38.79\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e19.78\\u0026ndash;76.08\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eInsulin/insulin\\u0026thinsp;+\\u0026thinsp;OHA\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e35\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e37.1%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e36.461\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e18.47\\u0026ndash;71.95\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.0001\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study, the prevalence of diabetic peripheral neuropathy (DPN) was observed to be 16.5% based on the MNSI questionnaire and 21.8% using the MNSI examination. These results are in line with those reported by D\\u0026rsquo;Souza et al., who documented prevalence rates of 18.3% and 32.2% with the respective MNSI components.⁶ Similarly, Al Kaabi et al. identified prevalence rates of 10.4% and 25.6% in a UAE population.⁷\\u003c/p\\u003e\\u003cp\\u003eReports from other Indian cohorts have demonstrated considerably higher prevalence, ranging between 47% in the study by George et al. and 51.8% in the study by Vibha et al.⁵˒⁸ The observed variation across studies may reflect differences in study populations, screening tools, diagnostic definitions, and duration of diabetes. Furthermore, the gap between questionnaire-based and examination-based prevalence underlines the greater sensitivity of clinical assessment, as symptom-based reporting alone may fail to capture subclinical or early-stage neuropathy.\\u003c/p\\u003e\\u003cp\\u003eConsistent with prior literature, the present analysis identified older age (\\u0026ge;\\u0026thinsp;60 years) and a longer duration of diabetes (\\u0026gt;\\u0026thinsp;5 years) as significant predictors of DPN.⁹\\u0026ndash;\\u0026sup1;\\u0026sup1; These associations can be explained by age-related degenerative changes, vascular insufficiency, and cumulative exposure to chronic hyperglycaemia, all of which contribute to progressive nerve damage. Lifestyle-related factors, including smoking and alcohol intake, were also positively associated with neuropathy, which corroborates evidence from previous investigations.\\u003c/p\\u003e\\u003cp\\u003eThe findings highlight the \\u0026ldquo;iceberg phenomenon\\u0026rdquo; of DPN, wherein a substantial proportion of individuals may remain asymptomatic until later stages. This emphasizes the importance of systematic neuropathy screening in primary care, particularly for elderly patients and those with long-standing diabetes, to enable early detection and timely intervention.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThis study demonstrates that diabetic peripheral neuropathy remains a significant complication among individuals with type 2 diabetes, with prevalence rates of 16.5% and 21.8% identified through the MNSI questionnaire and examination, respectively. The findings confirm that advancing age, longer disease duration, and lifestyle factors such as smoking and alcohol consumption are key determinants of neuropathy risk. The disparity between questionnaire- and examination-based outcomes further highlights the limitations of symptom-based reporting and underscores the necessity of clinical evaluation for accurate detection.\\u003c/p\\u003e\\u003cp\\u003eGiven the high burden and asymptomatic nature of early neuropathy, routine screening at the primary care level should be prioritized, particularly in elderly patients and those with diabetes of more than five years\\u0026rsquo; duration. Early identification and timely intervention could mitigate complications, improve quality of life, and reduce the long-term healthcare burden.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003ch2\\u003eEthics Approval and Consent to Participate\\u003c/h2\\u003e\\u003cp\\u003e Ethical clearance was obtained from the Ethics Committee, KG College of Physiotherapy, and Coimbatore. Written informed consent was obtained from all participants.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interests\\u003c/strong\\u003e\\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e\\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e\\u003cp\\u003eThis research received no external funding and was self-financed by the primary author.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eAuthors\\u0026rsquo; ContributionsConcept \\u0026amp; Design: Michael SelvarajSupervision: Manoj AbrahamData Collection \\u0026amp; Processing: Michael SelvarajAnalysis \\u0026amp; Interpretation: Michael Selvaraj, Franklin shajuLiterature Review: Michael Selvaraj,Manuscript Writing: Michael SelvarajCritical Review: Michael Selvaraj, Manoj Abraham,Franklin ShajuFunding \\u0026amp; References: Michael Selvaraj\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e\\u003cp\\u003eNone.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eFeldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5:41.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003ePop-Busui R, Boulton AJ, 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\\u0026ndash;54.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBommer C, Sagalova V, Heesemann E, Manne-Goehler J, Atun R, B\\u0026auml;rnighausen T, et al. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care. 2018;41(5):963\\u0026ndash;70. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.2337/dc17-1962\\u003c/span\\u003e\\u003cspan address=\\\"10.2337/dc17-1962\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCallaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. 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J Public Health Res. 2015;4:450.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eAl-Maskari F, El-Sadig M, Al-Kaabi JM, Afandi B, Nagelkerke N, Yeatts KB. Knowledge, attitudes, and practices of diabetic patients in the United Arab Emirates. PLoS ONE. 2013;8(1):e52857.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGeorge H, Rakesh P, Krishna M, Alex R, Abraham VJ, George K, et al. Foot care knowledge, practices, and prevalence of peripheral neuropathy among people with diabetes in a rural secondary hospital, South India. J Family Med Prim Care. 2013;2(1):27\\u0026ndash;32.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eGill HK, Yadav SB, Ramesh V, Bhatia E. Prevalence and association of peripheral neuropathy in newly diagnosed type 2 diabetes patients: a prospective study from India. J Postgrad Med. 2014;60(3):270\\u0026ndash;5.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBansal D, Gudala K, Muthyala H, Esam HP, Nayakallu R, Bhansali A. Risk factors for development of peripheral diabetic neuropathy in type 2 diabetes: a tertiary care study. J Diabetes Investig. 2014;5(6):714\\u0026ndash;21.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eBelmin J, Valensi P. Diabetic neuropathy in elderly patients: therapeutic perspectives. Drugs Aging. 1996;8(5):416\\u0026ndash;29.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Diabetic peripheral neuropathy, Michigan Neuropathy Screening Instrument, prevalence, risk factors\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7481785/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7481785/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e\\u003cbr\\u003e\\nDiabetic neuropathy is among the most prevalent complications of diabetes, affecting up to half of patients. Diabetic peripheral neuropathy (DPN), the most frequent form, predominantly involves the lower limbs and hands. Loss of protective sensation increases the risk of chronic injury, ulceration, and amputation. Since many cases of DPN remain asymptomatic, routine screening is vital for early detection and management.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eObjectives:\\u003c/strong\\u003e\\u003cbr\\u003e\\nTo determine the prevalence of DPN among patients with type 2 diabetes attending a rural health centre in Ooty, Tamil Nadu, and to examine associations with body mass index (BMI), physical activity, glycaemic control, smoking, alcohol intake, and sociodemographic variables.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e\\u003cbr\\u003e\\nA cross-sectional study was conducted among 156 patients with type 2 diabetes at an urban health centre. The Michigan Neuropathy Screening Instrument (MNSI), which includes a structured symptom questionnaire and physical examination, was used to identify neuropathy. Sociodemographic and clinical data were collected, and associations were analyzed statistically.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003c/strong\\u003e\\u003cbr\\u003e\\nOf the participants, 66.6% were male and 33.3% were female, with a mean age of 50.8 years (SD = 12.3). The mean duration of diabetes was 8.3 years (SD = 5.5). Prevalence of DPN was 16.5% by questionnaire and 21.8% by examination. DPN was significantly associated with older age (≥60 years; p \\u0026lt; 0.001, OR = 3.98) and longer duration of diabetes (≥5 years; p = 0.003, OR = 6.01).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion:\\u003c/strong\\u003e\\u003cbr\\u003e\\nA substantial proportion of patients with type 2 diabetes had unrecognized DPN. Older age and longer disease duration were key correlates. Incorporating validated screening tools such as the MNSI into routine care in primary health centres may facilitate earlier detection and timely management of DPN.\\u003c/p\\u003e\",\"manuscriptTitle\":\"The Prevalence of Diabetic Peripheral Neuropathy in Patients with Type 2 Diabetes Attending an Urban Health Centre\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-10-01 14:14:29\",\"doi\":\"10.21203/rs.3.rs-7481785/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"683a8628-b3eb-4a86-9447-b6f8ecaf4f7e\",\"owner\":[],\"postedDate\":\"October 1st, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-15T10:22:53+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-10-01 14:14:29\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7481785\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7481785\",\"identity\":\"rs-7481785\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}