Prevalence and associated factors of probable neuropathic pain among adults with type 2 diabetes in Turkish primary care: a cross-sectional study

Prevalence and associated factors of probable neuropathic pain among adults with type 2 diabetes in Turkish primary care: a cross-sectional study | 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 Prevalence and associated factors of probable neuropathic pain among adults with type 2 diabetes in Turkish primary care: a cross-sectional study Mehmet KARADAĞ, Öztürk Gürer TUTU, Veli BİLEN, Cahit ÖZER This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8561163/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Neuropathic pain is a common and disabling complication of type 2 diabetes mellitus (T2DM) that adversely affects quality of life and functional capacity, yet it is frequently under-recognised and undertreated, particularly in primary care. Most evidence on diabetic neuropathic pain comes from hospital-based populations, and data from Turkish primary care—especially among working-age adults—are limited. We aimed to estimate the prevalence of probable neuropathic pain among adults with T2DM in primary care and to identify associated demographic, clinical and laboratory factors. Methods Cross-sectional study of adults aged 18–65 years with T2DM duration ≥ 1 year registered at a family health centre in Türkiye. A stratified random sample of 400 patients was invited; 301 participated. Data were collected by interview and medical record review. Probable neuropathic pain was defined as the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) score ≥ 12. Associations were examined using multivariable logistic regression. Results Participants were 53.2% female; mean age 55.1 ± 9.7 years; median diabetes duration 120 months (interquartile range (IQR) 48–180). The prevalence of probable neuropathic pain was 25.9% (95% confidence interval (CI) 21.1–31.3). In the multivariable model, glycated haemoglobin (HbA1c) ≥ 9% (vs < 7%; odds ratio (OR) 2.29, 95% CI 1.11–4.75) and primary school or less education (vs university or higher; OR 3.04, 95% CI 1.01–9.13) were independently associated with probable neuropathic pain. Conclusions About one in four working-age adults with T2DM in primary care reported probable neuropathic pain. Screening and education-tailored counselling, alongside intensified support for glycaemic control, may be particularly important for patients with poor glycaemic control and lower education. Type 2 diabetes mellitus Neuropathic pain S-LANSS Primary health care Family medicine Figures Figure 1 Figure 2 Background Diabetes mellitus (DM) is a common chronic metabolic disorder associated with persistent hyperglycaemia and substantial global burden, with an estimated adult prevalence of 8.4% in 2017 projected to increase to 9.9% by 2045 [ 1 ]. Although acute metabolic complications have important short-term consequences, chronic macrovascular and microvascular complications such as neuropathy largely determine long-term quality of life and mortality in people with diabetes [ 2 ]. Diabetic neuropathy is one of the most common microvascular complications of DM and is frequently accompanied by neuropathic pain, defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory nervous system [ 3 , 4 ]. Neuropathic pain is typically characterised by burning, stabbing or tingling sensations and markedly impairs physical, psychological and social quality of life [ 3 , 5 ]. Up to half of individuals with diabetes may develop neuropathy during their lifetime, and hospital-based studies report neuropathy prevalences of around 25–30% in people with diabetes [ 6 – 11 ]. Early diagnosis of neuropathic pain is crucial for preventing progression and improving quality of life. Family medicine practices offer a unique opportunity for early detection through regular follow-up of individuals with diabetes [ 12 ]. However, in routine primary care, diabetic polyneuropathy is often not screened using standardised procedures or structured tools, as physicians tend to prioritise glycaemic control and cardiovascular risk factors over systematic neuropathy assessment [ 13 ], which hinders early recognition of neuropathic pain. Most studies on this topic have been conducted in hospital or endocrinology outpatient clinic settings, and data based on registered populations at the family medicine level remain quite limited. Therefore, epidemiological research using community-based data is valuable for enhancing family physicians’ awareness of diabetes-related complications and strengthening preventive approaches. To our knowledge, no previous study has quantified probable neuropathic pain using the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) in a registered family health centre (FHC) population in Türkiye. Building on this gap, we aimed to estimate the prevalence of S-LANSS–defined probable neuropathic pain among adults with type 2 diabetes mellitus (T2DM) registered at an FHC and to examine its associations with demographic, clinical and laboratory variables. Methods Study design and reporting We conducted an analytical cross-sectional study and report it in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [14]. Study setting and period The study was conducted between 1 January and 1 June 2025 in four family medicine units within a single FHC in southern Türkiye, which collectively provide care to approximately 4,293 adults with a recorded diagnosis of T2DM. Study population, sample and sampling method The sampling frame was constructed by screening the electronic records of a FHC to identify adults aged 18–65 years with a recorded diagnosis of T2DM for at least 1 year and documented literacy. Inclusion criteria were: willingness to participate; age between 18 and 65 years; a T2DM diagnosis of ≥1 year; and sufficient literacy to complete the questionnaire. Exclusion criteria were: pregnancy; active malignancy or active infection; overt rheumatological disease; congestive heart failure; stroke, Parkinson’s disease or other pronounced movement disorder; substance or alcohol dependence; cognitive impairment; and refusal to participate. Applying these eligibility criteria, 1,243 individuals were deemed suitable for inclusion. To ensure representation across family medicine units and minimise selection bias, we used unit-based stratified simple random sampling with equal allocation. Within each of the four family medicine units, 100 individuals were randomly selected from the registry lists using a computer-generated random number sequence (SPSS random number generator), yielding a target sample of 400 individuals. The selected individuals were contacted by telephone, informed about the study, and invited to attend the FHC, where written informed consent was obtained prior to data collection. Of the 400 invited individuals, 21 declined participation and 78 could not be reached. The study was therefore completed with 301 participants (Figure 1). Because only four units were included and intra-unit correlation for neuropathic pain was expected to be low, no additional cluster weighting or variance inflation was applied in the primary analyses. Sample size As this study aimed to estimate a prevalence (single proportion), the required sample size was calculated a priori using the formula n = Z²·p·(1−p)/d². Based on previous studies reporting the prevalence of diabetic peripheral neuropathy (DPN) in clinical/hospital populations to be in the range of 26–29% (e.g. 28.5% [7] ) and meta-analyses suggesting a prevalence of approximately 25–30% [15], the expected proportion was set at p = 0.26, with a 95% confidence level (Z = 1.96) and an absolute margin of error d = 0.05. Using these parameters, the required sample size was estimated as n ≈ 296. Anticipating a modest design effect due to unit-based stratified sampling (DEFF ≈ 1.1) and a potential non-response/loss rate of approximately 25%, the target sample size was inflated to n ≈ 400, with equal allocation and random selection from each unit. With the realised sample of 301 participants, the precision of the prevalence estimate remained close to the planned value (approximately ±5 percentage points for an expected prevalence of 26%). Data collection and measurements Data were collected via face-to-face interviews by a trained researcher using a structured questionnaire developed by the research team specifically for this study (not previously published). The questionnaire assessed sociodemographic and clinical characteristics, including age, sex, marital status, educational level, employment status, duration of diabetes, smoking and alcohol use, and comorbid conditions. An English-language version of the questionnaire is provided as Supplementary File 1. HbA1c values were obtained from the most recent laboratory record within the preceding three months. The primary outcome, “probable neuropathic pain”, was assessed using the S-LANSS scale. Evidence for the validity and reliability of the Turkish version has been reported in the literature [16, 17]. A cut-off score of ≥12 was accepted as indicating “probable neuropathic pain” [18, 19]. The scale is based on self-report, is brief to administer, and constitutes a practical screening tool in family medicine settings [16-19]. Minimisation of bias Selection bias: To reduce selection bias, unit-based stratified simple random sampling with equal allocation was employed, and the sampling frame was generated from FHC registration records. Information bias: To minimise information bias, the validated Turkish version of the S-LANSS scale was used [16, 17], and the data collector received standardised training prior to data collection. Non-response/missing data: Potential non-response bias was evaluated by comparing key characteristics (e.g. age, sex) of invited individuals and participants, where possible, and presenting these comparisons descriptively in a supplementary table . Mandatory field checks and double verification were performed during data collection for all variables used in the study. As the questionnaire was administered face-to-face and laboratory data (HbA1c) were verified from FHC records, no missing data occurred. Therefore, no imputation was applied. Variable definitions Outcome variable: The primary response outcome was the presence of probable neuropathic pain. Probable neuropathic pain was assessed using the Turkish version of the S-LANSS, a self-administered questionnaire consisting of 7 items with a total score ranging from 0 to 24; higher scores indicate a greater likelihood of neuropathic pain, and a score ≥12 was used as the cut-off to define probable neuropathic pain. For the purposes of the regression analyses, this outcome was coded as a binary variable. Covariates: The following covariates were included in the analyses based on clinical relevance and prior literature on DPN: Age (recorded in years as a continuous variable), Sex (coded as male or female), Duration of diabetes (time since diagnosis of diabetes, recorded in months and treated as a continuous variable), HbA1c (measured as a continuous percentage value, and additionally categorised into three groups for descriptive and stratified analyses: <7.0%, 7.0–8.9%, ≥9.0%, reflecting the guideline-recommended target for many nonpregnant adults (<7.0%) and commonly used quality thresholds defining poor glycaemic control (≥9.0%)) [20], Comorbid conditions (presence of common chronic comorbidities such as hypertension, chronic kidney disease and coronary heart disease, coded as binary variables (yes/no)), Sociodemographic characteristics (variables including educational level, employment status and other basic sociodemographic indicators, which were included as categorical covariates in the models). Statistical Analysis Descriptive statistics for numerical variables were presented as the median and interquartile range (IQR) (median [IQR: Q1–Q3]) or as the mean ± standard deviation (SD), while categorical variables were reported as frequencies and percentages. The prevalence was calculated using the Clopper-Pearson (Exact) formula. The normality of the variables was assessed using the Shapiro–Wilk test. Comparisons between two independent groups were performed using the Mann–Whitney U test for non-normally distributed variables and the Student’s t-test for normally distributed variables. Relationships between categorical variables were examined using Pearson’s chi-square test or Fisher’s exact test. Probable neuropathic pain was determined using the S-LANSS score. Cases with an S-LANSS score of 12 or higher were coded as having probable neuropathic pain. Variables such as age, gender, clinical characteristics, and other factors suspected to influence probable neuropathic pain were first analyzed using univariate logistic regression. Variables found to be statistically significant (p < 0.05) in the univariate analyses were included in a stepwise multivariate logistic regression model (Enter method). For age and diabetes duration, the sample mean was used as the cut-off value to derive binary variables, which were then entered into the multivariable logistic regression model. Binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). All hypotheses were evaluated using two-tailed tests, and a p-value < 0.05 was considered statistically significant. Data coding, data cleaning and statistical analyses were performed using SPSS for Windows, version 29 (SPSS Inc., Chicago, IL, USA). Results Among the 301 adults with T2DM, complete data were available for all variables; all analyses were conducted on the full sample (n=301). The mean age was 55.1 ± 9.67 years, and the median diabetes duration was 120 [IQR:48-180] months. Most participants were married and had primary school education, and comorbid conditions—particularly hypertension—were common. The median HbA1c was 7.4% [IQR: 6.6–8.9]. Probable neuropathic pain (S-LANSS ≥ 12) was present in 25.9% of the patients, with a median S-LANSS score of 4 [IQR: 1-12], indicating that nearly one-quarter of the cohort experienced clinically significant neuropathic pain symptoms (Table 1). Table 1. Baseline sociodemographic and clinical characteristics of participants (n =301) Variable n (%) Sex Female 160 (53.2) Male 141 (46.8) Age (years) mean±sd 55.1±9.67 Diabetes duration (months) median [IQR] 120 [48-180] Marital status Single 24 (8.0) Married 274 (91.0) Widowed/Divorced 3 (1.0) Education Primary school or less 168 (55.8) Secondary/High school 86 (28.6) University or higher 47 (15.6) Alcohol use Yes 30 (10.0) No 271 (90.0) Smoking status Current 100 (33.2) Never 201 (66.8) Work status Working 97 (32.2) Not working 204 (67.8) Comorbid conditions Present 197 (65.4) None 104 (34.6) Comorbid disease 0 104 (34.6) 1 152 (50.5) 2 41 (13.6) 3 4 (1.3) Hypertension Present 166 (55.1) None 135 (44.9) Heart Failure Present 23 (7.6) None 278 (92.4) Psychiatric Disorder Present 27 (9.0) None 274 (91.0) History of Stroke Present 30 (10.0) None 271 (90.0) HbA1c categories 9 73 (24.3) HbA1c (%) median [IQR] 7.4 [6.6-8.9] Neuropathic Pain Probable neuropathic pain S-LANSS≥12 78 (25.9) No neuropathic pain S-LANSS<12 223 (74.1) S LANSS median [IQR] 4 [1-12] Notes: Values are presented as n (%) or mean ± SD, or median [IQR], as appropriate. Abbreviations: SD, standard deviation; IQR, interquartile range [P25-P75]; HbA1c, glycated hemoglobin; S-LANSS, Self-administered Leeds Assessment of Neuropathic Symptoms and Signs. Of the 400 eligible individuals, 301 (75.3%) participated in the study and 99 (24.7%) did not respond. Non-responders did not differ significantly from responders in terms of mean age (55.10 ± 9.69 vs. 53.31 ± 8.14 years, respectively; p = 0.098, Student’s t test) or sex distribution (female: 53.2% vs. 54.5%, respectively; p = 0.810, chi-square/Cramer’s V) (Supplementary Table 1). Thus, non-response bias with respect to age and sex was unlikely to be substantial. Supplementary Table 1. Comparison of responders and non-responders in terms of age and sex Variable Responding (n=301) Non responding (n=99) p Age (mean±sd) 55.10±9.69 53.31±8.14 0.098 * Sex (Female n(%)) 160 (53.2) 54 (54.5) 0.810 + * p value: Student’s t-test; + p value: chi-square test (Cramer’s V) Compared with patients without neuropathic pain, those with probable neuropathic pain (S-LANSS ≥ 12) were older, had a longer duration of diabetes, and more frequently had lower educational levels (p < 0.001). Comorbid conditions—including hypertension—were significantly more common in the neuropathic pain group (p < 0.001). Additionally, non-working status was more prevalent among these patients (p = 0.004). Poor glycaemic control was also more frequent, as reflected by higher HbA1c values and a greater proportion of patients with HbA1c > 9% (p = 0.002). No significant differences were observed regarding sex, smoking status, alcohol use, heart failure, psychiatric disorders, or prior stroke (Table 2). Table 2. Prevalence of probable neuropathic pain (S-LANSS ≥12) overall and by subgroups Variable No neuropathic pain S-LANSS<12 (n=223) Probable neuropathic pain S-LANSS≥12 (n=78) Sex Female 117 (52.5) 43 (55.1) 0.685 * Male 106 (47.5) 35 (44.9) Age (years) mean±sd 53.95±9.49 58.38±9.48 < 0.001 + Diabetes duration (months) median [IQR] 99 [43-180] 144 [84-228] <0.001 # Marital status Single 17 (7.6) 7 (9.0) 0.554 * Married 203 (91.0) 71 (91.0) Widowed/Divorced 3 (1.3) 0 (0.0) Education Primary school or less 108 (48.4) 60 (76.9) <0.001 * Secondary/High school 73 (32.7) 13 (16.7) University or higher 42 (18.8) 5 (6.4) Alcohol use Yes 20 (9) 10 (12.8) 0.328 * No 203 (91.0) 68 (87.2) Smoking status Current 80 (35.9) 20 (25.6) 0.099 * Never 143 (64.1) 58 (74.4) Work status Working 82 (36.8) 15 (19.2) 0.004 * Not Working 141 (63.2) 63 (80.8) Comorbid conditions Present 131 (58.7) 66 (84.6) <0.001 * None 92 (41.3) 12 (15.4) Comorbid disease 0 92 (41.3) 12 (15.4) <0.001 * 1 99 (44.4) 53 (67.9) 2 29 (13.0) 12 (15.4) 3 3 (1.3) 1 (1.3) Hypertension Present 105 (47.1) 61 (78.2) <0.001 * None 118 (52.9) 17 (21.8) Heart Failure Present 14 (6.3) 9 (11.5) 0.132 * None 209 (93.7) 69 (88.5) Psychiatric Disorder Present 23 (10.3) 4 (5.1) 0.168 * None 200 (89.7) 74 (94.9) History of Stroke Present 24 (10.8) 6 (7.7) 0.436 * None 199 (89.2) 72 (92.3) HbA1c categories 9 44 (19.7) 29 (37.2) HbA1c (%) median [IQR] 7.2 [6.5-8.5] 7.9 [7-10.1] <0.001 # * P-value obtained from the Pearson’s chi-square test. + P-value obtained from the Student t-test, # P-value obtained from the Mann-Whitney U test. In the univariate logistic regression analyses, age ≥55 years, diabetes duration ≥120 months, higher HbA1c levels (≥9%), lower education levels, unemployment, presence of comorbidities, and hypertension were significantly associated with probable neuropathic pain (p < 0.05). However, in the multivariable logistic regression analysis, having an HbA1c level of ≥9%, when compared with individuals whose HbA1c was <7%, (OR: 2.294; 95% CI: 1.107–4.754; p = 0.026) and having a primary level of education, when compared with those with university education, (OR: 3.042; 95% CI: 1.014–9.126; p = 0.047) remained independently associated with neuropathic pain. All other variables—including age, duration of diabetes, employment status, comorbidities, and hypertension—did not retain statistical significance in the multivariate model (Table 3). The distribution of S-LANSS total scores was right-skewed and clearly bimodal, with a prominent cluster at low scores and a smaller secondary peak at higher scores (Figure 2). Discussion In this cross-sectional primary care–based study, we examined the prevalence of probable neuropathic pain defined as S-LANSS ≥ 12 and its associated factors among adults with T2DM followed in family health centres. The prevalence of probable neuropathic pain was 25.9%, which is broadly consistent with previous studies reporting diabetic neuropathy prevalence of 26–28.5% in hospital and clinic populations [ 7 , 9 ]. Although these hospital-based studies largely focused on clinically defined diabetic neuropathy rather than S-LANSS–defined probable neuropathic pain, the similar magnitude supports the clinical relevance of the burden observed in our primary care population. Our findings are noteworthy in that they demonstrate a similar burden within a registered population at the family medicine level, in a community-based sampling frame, and therefore highlight that neuropathic pain screening should not be overlooked in primary care diabetes management, in line with guideline recommendations for regular neuropathy assessment and evidence that screening is often not performed in a standardised way in routine practice [ 12 , 13 , 21 ]. Table 3 Univariate and Stepwise Multivariable Logistic Regression Analysis Evaluating Factors Associated with Probable Neuropathic Pain (S-LANSS ≥ 12) Variable Category / Unit Univariate LR OR (95% CI) p Multivariable LR OR (95% CI) p Age ≥ 55 years 2.032 (1.161–3.556) 0.013 0.946 (0.481–1.858) 0.872 Sex Female vs Male (ref) 0.898 (0.535–1.508) 0.685 Diabetes duration ≥ 120 month 1.859 (1.104–3.128) 0.020 1.610 (0.880–2.944) 0.122 HbA1c categories 7–9% vs < 7% (ref) 1.754 (0.924–3.331) 0.086 1.364 (0.686–2.712) 0.376 ≥ 9% vs < 7% (ref) 3.230 (1.650–6.321) < 0.001 2.294 (1.107–4.754) 0.026 Smoking Current vs Never (ref) 0.616 (0.346–1.098) 0.100 Alcohol use Yes vs No (ref) 1.493 (0.666–3.346) 0.331 Education Primary school or less vs University or higher (ref) 4.667 (1.752–12.427) 0.002 3.042 (1.014–9.126) 0.047 Secondary/High school vs University or higher (ref) 1.496 (0.498–4.490) 0.473 1.483 (0.451–4.874) 0.516 Marital status Married vs Not married (ref) 0.737 (0.314–1.728) 0.483 Work status Not Working vs Working (ref) 2.443 (1.307–4.565) 0.005 0.807 (0.374–1.738) 0.584 Comorbidity ≥ 1 vs none 3.863 (1.976–7.551) < 0.001 2.143 (0.644–7.133) 0.214 Hypertension Present vs none (ref) 4.032 (2.217–7.336) < 0.001 1.509 (0.485–4.695) 0.477 Heart Failure Present vs none (ref) 1.947 (0.807–4.697) 0.138 Psychiatric Disorder Present vs none (ref) 0.470 (0.157–1.405) 0.177 History of Stroke Present vs none (ref) 0.691 (0.271–1.759) 0.438 LR, logistic regression; OR, odds ratio; CI, confidence interval. Variables with p < 0.05 in univariate analyses were entered into the multivariable model. The right-skewed, bimodal S-LANSS histogram suggests a predominantly low-score group and a smaller subgroup with higher neuropathic symptom burden, a pattern also reported in prior clinical/postal and community applications of S-LANSS [ 18 , 19 , 22 ]. The frequent score of 0 is consistent with a floor effect in community samples and supports using the ≥ 12 threshold to flag patients who may benefit from further assessment and targeted management in primary care [ 19 , 22 ]. In univariate comparisons between groups, age, diabetes duration, educational level, employment status, comorbidity, hypertension and HbA1c levels all showed statistically significant differences between those with and without probable neuropathic pain (p < 0.05). This pattern is consistent with prior evidence indicating that both classical clinical determinants (e.g. age, duration, cardiometabolic comorbidities) and social determinants are associated with DPN and related pain outcomes [ 2 , 10 , 11 , 23 – 29 ]. However, several of these associations attenuated in multivariable models, highlighting the interrelationships and potential confounding among these factors. Age, diabetes duration, unemployment, higher comorbidity burden and hypertension were associated with probable neuropathic pain in univariate analyses, consistent with cumulative metabolic injury and vascular mechanisms reported in prior work [ 10 , 11 , 30 , 31 ]. However, these variables did not retain independent significance in the multivariable model, suggesting that their apparent effects were largely captured by more proximal and interrelated determinants such as glycaemic control and socio-educational factors, as well as overall cardiometabolic risk [ 10 , 11 , 26 – 28 ]. Although risk tends to rise with age and longer diabetes duration, guidelines emphasise that modifiable factors—especially glycaemic control and multifactorial vascular risk management—remain the main intervention targets in primary care [ 21 , 27 ]. Social determinants that cluster with unemployment and multimorbidity may influence self-management, but structured primary care support and good metabolic control may mitigate excess risk [ 2 , 12 , 29 ]. In contrast, the association between higher HbA1c and probable neuropathic pain remained robust. The proportion with probable neuropathic pain increased with higher HbA1c, was highest in the ≥ 9% group, and this relationship retained statistical significance in multivariable analyses. This finding aligns with meta-analyses demonstrating HbA1c as a consistent risk marker for DPN and with Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications data showing that long-term glycaemic control reduces neuropathy [ 23 , 24 , 32 – 34 ]. Moreover, emerging evidence links glycaemic variability assessed by continuous glucose monitoring to DPN risk [ 35 ]. Educational level also remained independently associated with probable neuropathic pain: participants with primary school or less education had higher odds of probable neuropathic pain than those with university education, even after adjustment. This is consistent with cohort and registry data suggesting that lower educational attainment and other indicators of socioeconomic disadvantage are associated with increased risk of microvascular complications and DPN [ 23 , 25 , 33 , 34 ]. Educational level may partly act through health literacy and diabetes self-management, as lower education has been associated with poorer HbA1c, reduced engagement in foot care and screening, and less effective treatment adherence [ 12 , 25 , 36 ]. From a family medicine perspective, these findings suggest that neuropathic pain screening should be prioritised among patients with suboptimal HbA1c and low educational level, ideally embedded in structured chronic care visits that also address health literacy and self-management support [ 12 , 21 , 25 , 36 ]. Overall, our results indicate that once proximal determinants such as glycaemic status and socio-educational indicators are taken into account, the relative contribution of classical risk markers (e.g. age, diabetes duration, comorbidity, hypertension) diminishes [ 2 , 10 , 11 , 24 – 29 ]. At the same time, the strong crude associations of comorbidity burden and hypertension with probable neuropathic pain should heighten clinical vigilance; in patients with multiple chronic conditions, neuropathic pain screening should be incorporated as a systematic routine component of care [ 2 , 21 , 27 ]. Given the cross-sectional design of our study, the identified factors should be interpreted as correlates rather than causes of neuropathic pain, but the pattern of associations is consistent with mechanistic and longitudinal evidence [ 2 , 10 , 11 , 21 , 23 – 29 , 32 – 36 ]. Family medicine is an ideal setting to integrate neuropathic pain screening into routine diabetes follow-up and complication checks within the same visit [ 12 ]. Given evidence that standardised diabetic polyneuropathy screening is not consistently applied in practice and care often prioritises glycaemic and cardiovascular targets [ 13 , 27 ], our findings support embedding a brief tool such as S-LANSS into routine visits [ 16 – 19 , 22 , 27 , 36 ] and framing pain in line with the 2020 IASP definition to strengthen patient-centred assessment and communication [ 37 ]. This study has several strengths and offers a number of original contributions to the literature on diabetic neuropathic pain in primary care. First, the sampling frame was derived from the registered adult population of four family medicine units within a single FHC, rather than from hospital-based or convenience samples. By using unit-based stratified random sampling with equal allocation, we sought to obtain a sample broadly representative of adults with T2DM followed in routine primary care. This strengthens the external validity of our prevalence estimates and provides a realistic picture of the neuropathic pain burden in a real-world family medicine setting. Second, we used the validated Turkish version of the S-LANSS, a standardised and internationally recognised instrument, to identify probable neuropathic pain. To our knowledge, few studies in Türkiye have quantified probable neuropathic pain using S-LANSS specifically in a family medicine context, and even fewer have focused on registered primary care populations [ 16 – 19 , 22 , 24 ]. This study also has limitations. First, its cross-sectional design precludes causal inference; while poorer glycaemic control may contribute to neuropathic pain, pain itself can adversely affect lifestyle and treatment adherence and thereby worsen HbA1c [ 2 , 10 , 11 , 21 , 36 ]. The identified factors should therefore be interpreted as correlates rather than causes of neuropathic pain. Second, the single-centre nature of the study and restriction to individuals aged 18–65 years may limit generalisability to older age groups or populations with different socio-economic and cultural profiles [ 12 , 27 ]. Third, the S-LANSS is a screening tool that captures pain of predominantly neuropathic origin but does not distinguish diabetic neuropathy from other causes of neuropathic pain; we did not perform electrophysiological testing or detailed neurological examination for diagnostic confirmation [ 16 – 19 , 22 ]. Fourth, self-reported variables (e.g. smoking and alcohol use) are subject to information bias, and non-response among individuals who could not be reached or declined participation may have introduced some selection bias. Finally, residual confounding by unmeasured variables such as pain treatments, peripheral vascular disease or vitamin B12 levels cannot be excluded [ 2 , 10 , 11 , 27 ]. A further novel aspect of our work is the combined consideration of metabolic and socio-educational determinants of neuropathic pain within the same primary care cohort. In multivariable analyses, poor glycaemic control and lower educational attainment emerged as the only independent correlates that increased the frequency of probable neuropathic pain, whereas associations with age, diabetes duration, hypertension and other comorbidities attenuated after adjustment [ 2 , 10 , 11 , 23 – 29 , 32 – 35 ].This pattern suggests that neuropathic pain in T2DM is not merely a function of disease duration or comorbidity burden, but is closely linked to the intersection of sustained hyperglycaemia and social vulnerability. From a primary care perspective, these findings support the integration of simple neuropathic pain screening—such as the S-LANSS—into routine diabetes reviews, with particular priority given to individuals with suboptimal HbA1c levels and low educational level. Embedding such screening into structured chronic care visits could facilitate earlier recognition, more timely initiation of appropriate pharmacological and non-pharmacological treatments, and more patient-centred discussions about pain and self-management within family medicine [ 12 , 21 , 25 , 27 , 36 ]. Future multicentre prospective cohorts, screening–confirmation designs (S-LANSS followed by neurological confirmation), and pragmatic primary care interventions (education-based self-management, digital reminders, foot-care programmes) may help to identify effective strategies to reduce the burden of neuropathic pain. In addition, studies examining mediation and interaction effects of health literacy and socio-economic factors would help to clarify the pathways underlying the association with educational level [ 12 , 21 , 25 , 36 ]. Conclusions In this primary care–based cross-sectional study of adults with T2DM, approximately one in four participants met the S-LANSS criteria for probable neuropathic pain. In multivariable analyses, poor glycaemic control and lower educational attainment emerged as the only independent correlates of probable neuropathic pain, whereas crude associations with age, diabetes duration, hypertension and comorbidities attenuated after adjustment. These findings suggest that neuropathic pain in T2DM is shaped not only by metabolic risk but also by social vulnerability. From a family medicine perspective, they support integrating brief neuropathic pain screening tools such as the S-LANSS into routine diabetes reviews, with particular priority given to individuals with suboptimal HbA1c levels and low educational level, and evaluating in future studies whether such strategies improve early recognition, management and patient-centred outcomes in primary care. Abbreviations CI; Confidence interval, DEFF; Design effect, DM; Diabetes mellitus, DPN; Diabetic peripheral neuropathy, FHC; Family health centre, HbA1c; Glycated haemoglobin, IASP; International Association for the Study of Pain, IQR; Interquartile range, OR; Odds ratio, SD; Standard deviation, S-LANSS; Self-completed Leeds Assessment of Neuropathic Symptoms and Signs, STROBE; Strengthening the Reporting of Observational Studies in Epidemiology, T2DM; Type 2 diabetes mellitus. Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of Hatay Mustafa Kemal University (18.12.2024/03; approval date: 18 December 2024). Written informed consent was obtained from all participants prior to enrolment. All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki. Data were used solely for research purposes; personal identifiers were anonymised, and all study data were stored and managed in accordance with applicable ethical and data-protection principles. Consent for publication Not applicable. Availability of data and materials The de-identified dataset is available in the Zenodo repository, https://doi.org/10.5281/zenodo.17917391. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency. Authors’ contributions All authors contributed to the conception and design of the study. Data collection was performed by MK, ÖGT and VB. Statistical analysis was conducted by MK. All authors contributed to the writing of the manuscript. All authors critically revised the manuscript and approved the final version. Acknowledgements The authors would like to thank all participants for their time and cooperation. 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Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA et al : The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises . Pain 2020, 161 (9):1976-1982. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 17 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers agreed at journal 03 Mar, 2026 Reviewers agreed at journal 02 Mar, 2026 Reviews received at journal 21 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers invited by journal 29 Jan, 2026 Editor assigned by journal 21 Jan, 2026 Editor invited by journal 19 Jan, 2026 Submission checks completed at journal 16 Jan, 2026 First submitted to journal 16 Jan, 2026 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. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8561163","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":583542986,"identity":"7b533a5c-354e-43ea-9312-3fd8f9299235","order_by":0,"name":"Mehmet KARADAĞ","email":"","orcid":"","institution":"Hatay Mustafa Kemal University","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"KARADAĞ","suffix":""},{"id":583542987,"identity":"2793fcd1-58b4-49b7-b8b4-03e66ebb0772","order_by":1,"name":"Öztürk Gürer TUTU","email":"","orcid":"","institution":"Osmaniye State 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Kemal University","correspondingAuthor":false,"prefix":"","firstName":"Cahit","middleName":"","lastName":"ÖZER","suffix":""}],"badges":[],"createdAt":"2026-01-09 12:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8561163/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8561163/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101785712,"identity":"ad1d1fa5-9bbc-4cc6-8b71-d074b1a0610b","added_by":"auto","created_at":"2026-02-03 15:38:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":53465,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eParticipant flow diagram\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8561163/v1/88c782be6fd8c615bdabb12e.png"},{"id":101785710,"identity":"d11854df-cd89-4c51-93ce-4947d3d862a8","added_by":"auto","created_at":"2026-02-03 15:37:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":47706,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of S-LANSS Scores Among Participants\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8561163/v1/45986361100b791ccf601a25.png"},{"id":101880821,"identity":"0b66113a-c809-4c19-a826-a2df5d97e9af","added_by":"auto","created_at":"2026-02-04 15:06:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3211803,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8561163/v1/deba4d90-4cb6-44a2-8fa8-1a71355faba0.pdf"},{"id":101785711,"identity":"5ce445fa-a798-456b-9287-e38b7e6c1892","added_by":"auto","created_at":"2026-02-03 15:38:00","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16495,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8561163/v1/bd2147a7092533f46be0b654.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and associated factors of probable neuropathic pain among adults with type 2 diabetes in Turkish primary care: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eDiabetes mellitus (DM) is a common chronic metabolic disorder associated with persistent hyperglycaemia and substantial global burden, with an estimated adult prevalence of 8.4% in 2017 projected to increase to 9.9% by 2045 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough acute metabolic complications have important short-term consequences, chronic macrovascular and microvascular complications such as neuropathy largely determine long-term quality of life and mortality in people with diabetes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDiabetic neuropathy is one of the most common microvascular complications of DM and is frequently accompanied by neuropathic pain, defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory nervous system [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Neuropathic pain is typically characterised by burning, stabbing or tingling sensations and markedly impairs physical, psychological and social quality of life [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Up to half of individuals with diabetes may develop neuropathy during their lifetime, and hospital-based studies report neuropathy prevalences of around 25\u0026ndash;30% in people with diabetes [\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly diagnosis of neuropathic pain is crucial for preventing progression and improving quality of life. Family medicine practices offer a unique opportunity for early detection through regular follow-up of individuals with diabetes [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, in routine primary care, diabetic polyneuropathy is often not screened using standardised procedures or structured tools, as physicians tend to prioritise glycaemic control and cardiovascular risk factors over systematic neuropathy assessment [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], which hinders early recognition of neuropathic pain.\u003c/p\u003e \u003cp\u003eMost studies on this topic have been conducted in hospital or endocrinology outpatient clinic settings, and data based on registered populations at the family medicine level remain quite limited. Therefore, epidemiological research using community-based data is valuable for enhancing family physicians\u0026rsquo; awareness of diabetes-related complications and strengthening preventive approaches.\u003c/p\u003e \u003cp\u003eTo our knowledge, no previous study has quantified probable neuropathic pain using the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) in a registered family health centre (FHC) population in T\u0026uuml;rkiye. Building on this gap, we aimed to estimate the prevalence of S-LANSS\u0026ndash;defined probable neuropathic pain among adults with type 2 diabetes mellitus (T2DM) registered at an FHC and to examine its associations with demographic, clinical and laboratory variables.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and reporting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted an analytical cross-sectional study and report it in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [14].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy setting and period\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted between 1 January and 1 June 2025 in four family medicine units within a single FHC in southern T\u0026uuml;rkiye, which collectively provide care to approximately 4,293 adults with a recorded diagnosis of T2DM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population, sample and sampling method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sampling frame was constructed by screening the electronic records of a FHC to identify adults aged 18\u0026ndash;65 years with a recorded diagnosis of T2DM for at least 1 year and documented literacy. Inclusion criteria were: willingness to participate; age between 18 and 65 years; a T2DM diagnosis of \u0026ge;1 year; and sufficient literacy to complete the questionnaire. Exclusion criteria were: pregnancy; active malignancy or active infection; overt rheumatological disease; congestive heart failure; stroke, Parkinson\u0026rsquo;s disease or other pronounced movement disorder; substance or alcohol dependence; cognitive impairment; and refusal to participate.\u003c/p\u003e\n\u003cp\u003eApplying these eligibility criteria, 1,243 individuals were deemed suitable for inclusion. To ensure representation across family medicine units and minimise selection bias, we used unit-based stratified simple random sampling with equal allocation. Within each of the four family medicine units, 100 individuals were randomly selected from the registry lists using a computer-generated random number sequence (SPSS random number generator), yielding a target sample of 400 individuals. The selected individuals were contacted by telephone, informed about the study, and invited to attend the FHC, where written informed consent was obtained prior to data collection. Of the 400 invited individuals, 21 declined participation and 78 could not be reached. The study was therefore completed with 301 participants (Figure 1). Because only four units were included and intra-unit correlation for neuropathic pain was expected to be low, no additional cluster weighting or variance inflation was applied in the primary analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs this study aimed to estimate a prevalence (single proportion), the required sample size was calculated a priori using the formula n = Z\u0026sup2;\u0026middot;p\u0026middot;(1\u0026minus;p)/d\u0026sup2;. Based on previous studies reporting the prevalence of diabetic peripheral neuropathy (DPN) in clinical/hospital populations to be in the range of 26\u0026ndash;29% (e.g. 28.5% [7] ) and meta-analyses suggesting a prevalence of approximately 25\u0026ndash;30% [15], the expected proportion was set at p = 0.26, with a 95% confidence level (Z = 1.96) and an absolute margin of error d = 0.05. Using these parameters, the required sample size was estimated as n \u0026asymp; 296. Anticipating a modest design effect due to unit-based stratified sampling (DEFF \u0026asymp; 1.1) and a potential non-response/loss rate of approximately 25%, the target sample size was inflated to n \u0026asymp; 400, with equal allocation and random selection from each unit. With the realised sample of 301 participants, the precision of the prevalence estimate remained close to the planned value (approximately \u0026plusmn;5 percentage points for an expected prevalence of 26%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected via face-to-face interviews by a trained researcher using a structured questionnaire developed by the research team specifically for this study\u0026nbsp;(not previously published). The questionnaire assessed sociodemographic and clinical characteristics, including age, sex, marital status, educational level, employment status, duration of diabetes, smoking and alcohol use, and comorbid conditions. An English-language version of the questionnaire is provided as Supplementary File 1. HbA1c values were obtained from the most recent laboratory record within the preceding three months.\u003c/p\u003e\n\u003cp\u003eThe primary outcome, \u0026ldquo;probable neuropathic pain\u0026rdquo;, was assessed using the S-LANSS scale. Evidence for the validity and reliability of the Turkish version has been reported in the literature [16, 17]. A cut-off score of \u0026ge;12 was accepted as indicating \u0026ldquo;probable neuropathic pain\u0026rdquo; [18, 19]. The scale is based on self-report, is brief to administer, and constitutes a practical screening tool in family medicine settings [16-19].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMinimisation of bias\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSelection bias: To reduce selection bias, unit-based stratified simple random sampling with equal allocation was employed, and the sampling frame was generated from FHC registration records.\u003c/p\u003e\n\u003cp\u003eInformation bias: To minimise information bias, the validated Turkish version of the S-LANSS scale was used [16, 17], and the data collector received standardised training prior to data collection.\u003c/p\u003e\n\u003cp\u003eNon-response/missing data: Potential non-response bias was evaluated by comparing key characteristics (e.g. age, sex) of invited individuals and participants, where possible, and presenting these comparisons descriptively in a supplementary table\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eMandatory field checks and double verification were performed during data collection for all variables used in the study. As the questionnaire was administered face-to-face and laboratory data (HbA1c) were verified from FHC records, no missing data occurred. Therefore, no imputation was applied.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eVariable definitions\u0026nbsp;\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eOutcome variable: The primary response outcome was the presence of probable neuropathic pain. Probable neuropathic pain was assessed using the Turkish version of the S-LANSS, a self-administered questionnaire consisting of 7 items with a total score ranging from 0 to 24; higher scores indicate a greater likelihood of neuropathic pain, and a score \u0026ge;12 was used as the cut-off to define probable neuropathic pain. For the purposes of the regression analyses, this outcome was coded as a binary variable.\u003c/p\u003e\n\u003cp\u003eCovariates: The following covariates were included in the analyses based on clinical relevance and prior literature on DPN: Age (recorded in years as a continuous variable), Sex (coded as male or female), Duration of diabetes (time since diagnosis of diabetes, recorded in months and treated as a continuous variable), HbA1c (measured as a continuous percentage value, and additionally categorised into three groups for descriptive and stratified analyses: \u0026lt;7.0%, 7.0\u0026ndash;8.9%, \u0026ge;9.0%, reflecting the guideline-recommended target for many nonpregnant adults (\u0026lt;7.0%) and commonly used quality thresholds defining poor glycaemic control (\u0026ge;9.0%)) [20], Comorbid conditions (presence of common chronic comorbidities such as hypertension, chronic kidney disease and coronary heart disease, coded as binary variables (yes/no)), Sociodemographic characteristics (variables including educational level, employment status and other basic sociodemographic indicators, which were included as categorical covariates in the models).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics for numerical variables were presented as the median and interquartile range (IQR) (median [IQR: Q1\u0026ndash;Q3]) or as the mean \u0026plusmn; standard deviation (SD), while categorical variables were reported as frequencies and percentages. The prevalence was calculated using the Clopper-Pearson (Exact) formula. The normality of the variables was assessed using the Shapiro\u0026ndash;Wilk test. Comparisons between two independent groups were performed using the Mann\u0026ndash;Whitney U test for non-normally distributed variables and the Student\u0026rsquo;s t-test for normally distributed variables. Relationships between categorical variables were examined using Pearson\u0026rsquo;s chi-square test or Fisher\u0026rsquo;s exact test. Probable neuropathic pain was determined using the S-LANSS score. Cases with an S-LANSS score of 12 or higher were coded as having probable neuropathic pain. Variables such as age, gender, clinical characteristics, and other factors suspected to influence probable neuropathic pain were first analyzed using univariate logistic regression. Variables found to be statistically significant (p \u0026lt; 0.05) in the univariate analyses were \u0026nbsp;included in a stepwise multivariate logistic regression model (Enter method). For age and diabetes duration, the sample mean was used as the cut-off value to derive binary variables, which were then entered into the multivariable logistic regression model. Binary logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). All hypotheses were evaluated using two-tailed tests, and a p-value \u0026lt; 0.05 was considered statistically significant. Data coding, data cleaning and statistical analyses were performed using SPSS for Windows, version 29 (SPSS Inc., Chicago, IL, USA).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 301 adults with T2DM, complete data were available for all variables; all analyses were conducted on the full sample (n=301). The mean age was 55.1 \u0026plusmn; 9.67 years, and the median diabetes duration was 120 [IQR:48-180] months. Most participants were married and had primary school education, and comorbid conditions\u0026mdash;particularly hypertension\u0026mdash;were common. The median HbA1c was 7.4% [IQR: 6.6\u0026ndash;8.9]. Probable neuropathic pain (S-LANSS \u0026ge; 12) was present in 25.9% of the patients, with a median S-LANSS score of 4 [IQR: 1-12], indicating that nearly one-quarter of the cohort experienced clinically significant neuropathic pain symptoms (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Baseline sociodemographic and clinical characteristics of participants (n =301)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e160 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e141 (46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e (years) mean\u0026plusmn;sd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e55.1\u0026plusmn;9.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes duration (months)\u003c/strong\u003e median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e120 [48-180]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e24 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e274 (91.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eWidowed/Divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e3 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003ePrimary school or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e168 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eSecondary/High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e86 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eUniversity or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e47 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e30 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e271 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eCurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e100 (33.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e201 (66.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eWorking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e97 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eNot working\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e204 (67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbid conditions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e197 (65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e104 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbid disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e104 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e152 (50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e41 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e4 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e166 (55.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e135 (44.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart Failure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e23 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e278 (92.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric Disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e27 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e274 (91.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of Stroke\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e30 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e271 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1c categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u0026lt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e118 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e7\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e110 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u0026gt;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e73 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1c (%) median [IQR]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e7.4 [6.6-8.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeuropathic Pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eProbable neuropathic pain\u0026nbsp;S-LANSS\u0026ge;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e78 (25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003eNo neuropathic pain\u0026nbsp;S-LANSS\u0026lt;12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e223 (74.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 391px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS LANSS\u003c/strong\u003e median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 185px;\"\u003e\n \u003cp\u003e4 [1-12]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNotes: Values are presented as n (%) or mean \u0026plusmn; SD, or median [IQR], as appropriate. Abbreviations: SD, standard deviation; IQR, interquartile range [P25-P75]; HbA1c, glycated hemoglobin; S-LANSS, Self-administered Leeds Assessment of Neuropathic Symptoms and Signs.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOf the 400 eligible individuals, 301 (75.3%) participated in the study and 99 (24.7%) did not respond. Non-responders did not differ significantly from responders in terms of mean age (55.10 \u0026plusmn; 9.69 vs. 53.31 \u0026plusmn; 8.14 years, respectively; \u003cem\u003ep\u003c/em\u003e = 0.098, Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e test) or sex distribution (female: 53.2% vs. 54.5%, respectively; \u003cem\u003ep\u003c/em\u003e = 0.810, chi-square/Cramer\u0026rsquo;s V) (Supplementary Table 1). Thus, non-response bias with respect to age and sex was unlikely to be substantial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Table 1. Comparison of responders and non-responders in terms of age and sex\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponding (n=301)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon responding (n=99)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (mean\u0026plusmn;sd)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e55.10\u0026plusmn;9.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e53.31\u0026plusmn;8.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.098\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex (Female n(%))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e160 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e54 (54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.810\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003e* p value: Student\u0026rsquo;s t-test; + p value: chi-square test (Cramer\u0026rsquo;s V)\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCompared with patients without neuropathic pain, those with probable neuropathic pain (S-LANSS \u0026ge; 12) were older, had a longer duration of diabetes, and more frequently had lower educational levels (p \u0026lt; 0.001). Comorbid conditions\u0026mdash;including hypertension\u0026mdash;were significantly more common in the neuropathic pain group (p \u0026lt; 0.001). Additionally, non-working status was more prevalent among these patients (p = 0.004). Poor glycaemic control was also more frequent, as reflected by higher HbA1c values and a greater proportion of patients with HbA1c \u0026gt; 9% (p = 0.002). No significant differences were observed regarding sex, smoking status, alcohol use, heart failure, psychiatric disorders, or prior stroke (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Prevalence of probable neuropathic pain (S-LANSS \u0026ge;12) overall and by subgroups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo neuropathic pain\u0026nbsp;S-LANSS\u0026lt;12 (n=223)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProbable neuropathic pain\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;S-LANSS\u0026ge;12 (n=78)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e117 (52.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e43 (55.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.685\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e106 (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e35 (44.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years) mean\u0026plusmn;sd\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e53.95\u0026plusmn;9.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e58.38\u0026plusmn;9.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026lt;\u003cstrong\u003e0.001\u003csup\u003e+\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes duration (months)\u0026nbsp;\u003c/strong\u003emedian [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e99 [43-180]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e144 [84-228]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e17 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e7 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.554\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e203 (91.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e71 (91.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eWidowed/Divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003ePrimary school or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e108 (48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e60 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eSecondary/High school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e73 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e13 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eUniversity or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e42 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e5 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e20 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e10 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.328\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e203 (91.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e68 (87.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eCurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e80 (35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e20 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.099\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e143 (64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e58 (74.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eWorking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e82 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e15 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNot Working\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e141 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e63 (80.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbid conditions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e131 (58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e66 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e92 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e12 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbid disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e92 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e12 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e99 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e53 (67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e29 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e12 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e3 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e1 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e105 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e61 (78.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e118 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e17 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart Failure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e14 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e9 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.132\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e209 (93.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e69 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychiatric Disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e23 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e4 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.168\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e200 (89.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e74 (94.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of Stroke\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e24 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e6 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e0.436\u003cstrong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e199 (89.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e72 (92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1c categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026lt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e98 (43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e20 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e7\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e81 (36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e29 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026gt;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e44 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e29 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHbA1c (%)\u003c/strong\u003e median [IQR]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e7.2 [6.5-8.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e7.9 [7-10.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003csup\u003e#\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e* P-value obtained from the Pearson\u0026rsquo;s chi-square test. + P-value obtained from the Student t-test, \u0026nbsp;# \u0026nbsp;P-value obtained from the Mann-Whitney U test.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the univariate logistic regression analyses, age \u0026ge;55 years, diabetes duration \u0026ge;120 months, higher HbA1c levels (\u0026ge;9%), lower education levels, unemployment, presence of comorbidities, and hypertension were significantly associated with probable neuropathic pain (p \u0026lt; 0.05). However, in the multivariable logistic regression analysis, having an HbA1c level of \u0026ge;9%, when compared with individuals whose HbA1c was \u0026lt;7%, (OR: 2.294; 95% CI: 1.107\u0026ndash;4.754; p = 0.026) and having a primary level of education, when compared with those with university education, (OR: 3.042; 95% CI: 1.014\u0026ndash;9.126; p = 0.047) remained independently associated with neuropathic pain. All other variables\u0026mdash;including age, duration of diabetes, employment status, comorbidities, and hypertension\u0026mdash;did not retain statistical significance in the multivariate model (Table 3).\u003c/p\u003e\n\u003cp\u003eThe distribution of S-LANSS total scores was right-skewed and clearly bimodal, with a prominent cluster at low scores and a smaller secondary peak at higher scores (Figure 2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this cross-sectional primary care\u0026ndash;based study, we examined the prevalence of probable neuropathic pain defined as S-LANSS\u0026thinsp;\u0026ge;\u0026thinsp;12 and its associated factors among adults with T2DM followed in family health centres. The prevalence of probable neuropathic pain was 25.9%, which is broadly consistent with previous studies reporting diabetic neuropathy prevalence of 26\u0026ndash;28.5% in hospital and clinic populations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Although these hospital-based studies largely focused on clinically defined diabetic neuropathy rather than S-LANSS\u0026ndash;defined probable neuropathic pain, the similar magnitude supports the clinical relevance of the burden observed in our primary care population. Our findings are noteworthy in that they demonstrate a similar burden within a registered population at the family medicine level, in a community-based sampling frame, and therefore highlight that neuropathic pain screening should not be overlooked in primary care diabetes management, in line with guideline recommendations for regular neuropathy assessment and evidence that screening is often not performed in a standardised way in routine practice [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and Stepwise Multivariable Logistic Regression Analysis Evaluating Factors Associated with Probable Neuropathic Pain (S-LANSS\u0026thinsp;\u0026ge;\u0026thinsp;12)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory / Unit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnivariate LR\u003c/p\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMultivariable LR\u003c/p\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;55 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.032 (1.161\u0026ndash;3.556)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.946 (0.481\u0026ndash;1.858)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale vs Male (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.898 (0.535\u0026ndash;1.508)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetes duration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;120 month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.859 (1.104\u0026ndash;3.128)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.610 (0.880\u0026ndash;2.944)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHbA1c categories\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026ndash;9% vs\u0026thinsp;\u0026lt;\u0026thinsp;7% (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.754 (0.924\u0026ndash;3.331)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.364 (0.686\u0026ndash;2.712)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;9% vs\u0026thinsp;\u0026lt;\u0026thinsp;7% (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.230 (1.650\u0026ndash;6.321)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.294 (1.107\u0026ndash;4.754)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrent vs Never (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.616 (0.346\u0026ndash;1.098)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes vs No (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.493 (0.666\u0026ndash;3.346)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school or less vs University or higher (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.667 (1.752\u0026ndash;12.427)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.042 (1.014\u0026ndash;9.126)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.047\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary/High school vs University or higher (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.496 (0.498\u0026ndash;4.490)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.483 (0.451\u0026ndash;4.874)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.516\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried vs Not married (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.737 (0.314\u0026ndash;1.728)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWork status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot Working vs Working (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.443 (1.307\u0026ndash;4.565)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.807 (0.374\u0026ndash;1.738)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.584\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1 vs none\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.863 (1.976\u0026ndash;7.551)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.143 (0.644\u0026ndash;7.133)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent vs none (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.032 (2.217\u0026ndash;7.336)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.509 (0.485\u0026ndash;4.695)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeart Failure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent vs none (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.947 (0.807\u0026ndash;4.697)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychiatric Disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent vs none (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.470 (0.157\u0026ndash;1.405)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHistory of Stroke\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent vs none (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.691 (0.271\u0026ndash;1.759)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eLR, logistic regression; OR, odds ratio; CI, confidence interval. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate analyses were entered into the multivariable model.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe right-skewed, bimodal S-LANSS histogram suggests a predominantly low-score group and a smaller subgroup with higher neuropathic symptom burden, a pattern also reported in prior clinical/postal and community applications of S-LANSS [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The frequent score of 0 is consistent with a floor effect in community samples and supports using the \u0026ge;\u0026thinsp;12 threshold to flag patients who may benefit from further assessment and targeted management in primary care [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn univariate comparisons between groups, age, diabetes duration, educational level, employment status, comorbidity, hypertension and HbA1c levels all showed statistically significant differences between those with and without probable neuropathic pain (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This pattern is consistent with prior evidence indicating that both classical clinical determinants (e.g. age, duration, cardiometabolic comorbidities) and social determinants are associated with DPN and related pain outcomes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, several of these associations attenuated in multivariable models, highlighting the interrelationships and potential confounding among these factors.\u003c/p\u003e \u003cp\u003eAge, diabetes duration, unemployment, higher comorbidity burden and hypertension were associated with probable neuropathic pain in univariate analyses, consistent with cumulative metabolic injury and vascular mechanisms reported in prior work [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. However, these variables did not retain independent significance in the multivariable model, suggesting that their apparent effects were largely captured by more proximal and interrelated determinants such as glycaemic control and socio-educational factors, as well as overall cardiometabolic risk [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Although risk tends to rise with age and longer diabetes duration, guidelines emphasise that modifiable factors\u0026mdash;especially glycaemic control and multifactorial vascular risk management\u0026mdash;remain the main intervention targets in primary care [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Social determinants that cluster with unemployment and multimorbidity may influence self-management, but structured primary care support and good metabolic control may mitigate excess risk [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn contrast, the association between higher HbA1c and probable neuropathic pain remained robust. The proportion with probable neuropathic pain increased with higher HbA1c, was highest in the \u0026ge;\u0026thinsp;9% group, and this relationship retained statistical significance in multivariable analyses. This finding aligns with meta-analyses demonstrating HbA1c as a consistent risk marker for DPN and with Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications data showing that long-term glycaemic control reduces neuropathy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Moreover, emerging evidence links glycaemic variability assessed by continuous glucose monitoring to DPN risk [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Educational level also remained independently associated with probable neuropathic pain: participants with primary school or less education had higher odds of probable neuropathic pain than those with university education, even after adjustment. This is consistent with cohort and registry data suggesting that lower educational attainment and other indicators of socioeconomic disadvantage are associated with increased risk of microvascular complications and DPN [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Educational level may partly act through health literacy and diabetes self-management, as lower education has been associated with poorer HbA1c, reduced engagement in foot care and screening, and less effective treatment adherence [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. From a family medicine perspective, these findings suggest that neuropathic pain screening should be prioritised among patients with suboptimal HbA1c and low educational level, ideally embedded in structured chronic care visits that also address health literacy and self-management support [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOverall, our results indicate that once proximal determinants such as glycaemic status and socio-educational indicators are taken into account, the relative contribution of classical risk markers (e.g. age, diabetes duration, comorbidity, hypertension) diminishes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25 CR26 CR27 CR28\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. At the same time, the strong crude associations of comorbidity burden and hypertension with probable neuropathic pain should heighten clinical vigilance; in patients with multiple chronic conditions, neuropathic pain screening should be incorporated as a systematic routine component of care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Given the cross-sectional design of our study, the identified factors should be interpreted as correlates rather than causes of neuropathic pain, but the pattern of associations is consistent with mechanistic and longitudinal evidence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFamily medicine is an ideal setting to integrate neuropathic pain screening into routine diabetes follow-up and complication checks within the same visit [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Given evidence that standardised diabetic polyneuropathy screening is not consistently applied in practice and care often prioritises glycaemic and cardiovascular targets [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], our findings support embedding a brief tool such as S-LANSS into routine visits [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and framing pain in line with the 2020 IASP definition to strengthen patient-centred assessment and communication [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has several strengths and offers a number of original contributions to the literature on diabetic neuropathic pain in primary care. First, the sampling frame was derived from the registered adult population of four family medicine units within a single FHC, rather than from hospital-based or convenience samples. By using unit-based stratified random sampling with equal allocation, we sought to obtain a sample broadly representative of adults with T2DM followed in routine primary care. This strengthens the external validity of our prevalence estimates and provides a realistic picture of the neuropathic pain burden in a real-world family medicine setting. Second, we used the validated Turkish version of the S-LANSS, a standardised and internationally recognised instrument, to identify probable neuropathic pain. To our knowledge, few studies in T\u0026uuml;rkiye have quantified probable neuropathic pain using S-LANSS specifically in a family medicine context, and even fewer have focused on registered primary care populations [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study also has limitations. First, its cross-sectional design precludes causal inference; while poorer glycaemic control may contribute to neuropathic pain, pain itself can adversely affect lifestyle and treatment adherence and thereby worsen HbA1c [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The identified factors should therefore be interpreted as correlates rather than causes of neuropathic pain. Second, the single-centre nature of the study and restriction to individuals aged 18\u0026ndash;65 years may limit generalisability to older age groups or populations with different socio-economic and cultural profiles [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Third, the S-LANSS is a screening tool that captures pain of predominantly neuropathic origin but does not distinguish diabetic neuropathy from other causes of neuropathic pain; we did not perform electrophysiological testing or detailed neurological examination for diagnostic confirmation [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Fourth, self-reported variables (e.g. smoking and alcohol use) are subject to information bias, and non-response among individuals who could not be reached or declined participation may have introduced some selection bias. Finally, residual confounding by unmeasured variables such as pain treatments, peripheral vascular disease or vitamin B12 levels cannot be excluded [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA further novel aspect of our work is the combined consideration of metabolic and socio-educational determinants of neuropathic pain within the same primary care cohort. In multivariable analyses, poor glycaemic control and lower educational attainment emerged as the only independent correlates that increased the frequency of probable neuropathic pain, whereas associations with age, diabetes duration, hypertension and other comorbidities attenuated after adjustment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27 CR28\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33 CR34\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].This pattern suggests that neuropathic pain in T2DM is not merely a function of disease duration or comorbidity burden, but is closely linked to the intersection of sustained hyperglycaemia and social vulnerability. From a primary care perspective, these findings support the integration of simple neuropathic pain screening\u0026mdash;such as the S-LANSS\u0026mdash;into routine diabetes reviews, with particular priority given to individuals with suboptimal HbA1c levels and low educational level. Embedding such screening into structured chronic care visits could facilitate earlier recognition, more timely initiation of appropriate pharmacological and non-pharmacological treatments, and more patient-centred discussions about pain and self-management within family medicine [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFuture multicentre prospective cohorts, screening\u0026ndash;confirmation designs (S-LANSS followed by neurological confirmation), and pragmatic primary care interventions (education-based self-management, digital reminders, foot-care programmes) may help to identify effective strategies to reduce the burden of neuropathic pain. In addition, studies examining mediation and interaction effects of health literacy and socio-economic factors would help to clarify the pathways underlying the association with educational level [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this primary care\u0026ndash;based cross-sectional study of adults with T2DM, approximately one in four participants met the S-LANSS criteria for probable neuropathic pain. In multivariable analyses, poor glycaemic control and lower educational attainment emerged as the only independent correlates of probable neuropathic pain, whereas crude associations with age, diabetes duration, hypertension and comorbidities attenuated after adjustment. These findings suggest that neuropathic pain in T2DM is shaped not only by metabolic risk but also by social vulnerability. From a family medicine perspective, they support integrating brief neuropathic pain screening tools such as the S-LANSS into routine diabetes reviews, with particular priority given to individuals with suboptimal HbA1c levels and low educational level, and evaluating in future studies whether such strategies improve early recognition, management and patient-centred outcomes in primary care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCI; Confidence interval, DEFF; Design effect, DM; Diabetes mellitus, DPN; Diabetic peripheral neuropathy, FHC; Family health centre, HbA1c; Glycated haemoglobin, IASP; International Association for the Study of Pain, IQR; Interquartile range, OR; Odds ratio, SD; Standard deviation, S-LANSS; Self-completed Leeds Assessment of Neuropathic Symptoms and Signs, STROBE; Strengthening the Reporting of Observational Studies in Epidemiology, T2DM; Type 2 diabetes mellitus.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Hatay Mustafa Kemal University (18.12.2024/03; approval date: 18 December 2024). Written informed consent was obtained from all participants prior to enrolment. All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki. Data were used solely for research purposes; personal identifiers were anonymised, and all study data were stored and managed in accordance with applicable ethical and data-protection principles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe de-identified dataset is available in the Zenodo repository, https://doi.org/10.5281/zenodo.17917391.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception and design of the study. Data collection was performed by MK, \u0026Ouml;GT and VB. Statistical analysis was conducted by MK. All authors contributed to the writing of the manuscript. All authors critically revised the manuscript and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participants for their time and cooperation. We also thank the Hatay Provincial Directorate of Health and the Hatay D\u0026ouml;rtyol \u0026Ouml;zerli No. 4 Family Health Center for their support and assistance during participant recruitment and data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, Malanda B: \u003cstrong\u003eIDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045\u003c/strong\u003e. \u003cem\u003eDiabetes Res Clin Pract \u003c/em\u003e2018, \u003cstrong\u003e138\u003c/strong\u003e:271-281.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eDiabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu \u003c/strong\u003e[https://file.temd.org.tr/Uploads/publications/guides/documents/diabetesmellitus2024.pdf]\u003c/li\u003e\n\u003cli\u003eRosenberger DC, Blechschmidt V, Timmerman H, Wolff A, Treede RD: \u003cstrong\u003eChallenges of neuropathic pain: focus on diabetic neuropathy\u003c/strong\u003e. \u003cem\u003eJ Neural Transm (Vienna) \u003c/em\u003e2020, \u003cstrong\u003e127\u003c/strong\u003e(4):589-624.\u003c/li\u003e\n\u003cli\u003eFinnerup NB, Kuner R, Jensen TS: \u003cstrong\u003eNeuropathic Pain: From Mechanisms to Treatment\u003c/strong\u003e. \u003cem\u003ePhysiol Rev \u003c/em\u003e2021, \u003cstrong\u003e101\u003c/strong\u003e(1):259-301.\u003c/li\u003e\n\u003cli\u003eBreivik H: \u003cstrong\u003eOpioids in chronic non-cancer pain, indications and controversies\u003c/strong\u003e. \u003cem\u003eEur J Pain \u003c/em\u003e2005, \u003cstrong\u003e9\u003c/strong\u003e(2):127-130.\u003c/li\u003e\n\u003cli\u003eDyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, Wilson DM, O\u0026apos;Brien PC, Melton LJ, 3rd, Service FJ: \u003cstrong\u003eThe prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study\u003c/strong\u003e. \u003cem\u003eNeurology \u003c/em\u003e1993, \u003cstrong\u003e43\u003c/strong\u003e(4):817-824.\u003c/li\u003e\n\u003cli\u003eYoung MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH: \u003cstrong\u003eA multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population\u003c/strong\u003e. \u003cem\u003eDiabetologia \u003c/em\u003e1993, \u003cstrong\u003e36\u003c/strong\u003e(2):150-154.\u003c/li\u003e\n\u003cli\u003eEdwards JL, Vincent AM, Cheng HT, Feldman EL: \u003cstrong\u003eDiabetic neuropathy: mechanisms to management\u003c/strong\u003e. \u003cem\u003ePharmacol Ther \u003c/em\u003e2008, \u003cstrong\u003e120\u003c/strong\u003e(1):1-34.\u003c/li\u003e\n\u003cli\u003eJaiswal M, Lauer A, Martin CL, Bell RA, Divers J, Dabelea D, Pettitt DJ, Saydah S, Pihoker C, Standiford DA\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003ePeripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study\u003c/strong\u003e. \u003cem\u003eDiabetes Care \u003c/em\u003e2013, \u003cstrong\u003e36\u003c/strong\u003e(12):3903-3908.\u003c/li\u003e\n\u003cli\u003eSloan G, Selvarajah D, Tesfaye S: \u003cstrong\u003ePathogenesis, diagnosis and clinical management of diabetic sensorimotor peripheral neuropathy\u003c/strong\u003e. \u003cem\u003eNat Rev Endocrinol \u003c/em\u003e2021, \u003cstrong\u003e17\u003c/strong\u003e(7):400-420.\u003c/li\u003e\n\u003cli\u003eElafros MA, Andersen H, Bennett DL, Savelieff MG, Viswanathan V, Callaghan BC, Feldman EL: \u003cstrong\u003eTowards prevention of diabetic peripheral neuropathy: clinical presentation, pathogenesis, and new treatments\u003c/strong\u003e. \u003cem\u003eLancet Neurol \u003c/em\u003e2022, \u003cstrong\u003e21\u003c/strong\u003e(10):922-936.\u003c/li\u003e\n\u003cli\u003eWindak A, Rochfort A, Jacquet J: \u003cstrong\u003eThe revised European Definition of General Practice/Family Medicine. 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\u003cstrong\u003e161\u003c/strong\u003e(9):1976-1982.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Type 2 diabetes mellitus, Neuropathic pain, S-LANSS, Primary health care, Family medicine","lastPublishedDoi":"10.21203/rs.3.rs-8561163/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8561163/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNeuropathic pain is a common and disabling complication of type 2 diabetes mellitus (T2DM) that adversely affects quality of life and functional capacity, yet it is frequently under-recognised and undertreated, particularly in primary care. Most evidence on diabetic neuropathic pain comes from hospital-based populations, and data from Turkish primary care\u0026mdash;especially among working-age adults\u0026mdash;are limited. We aimed to estimate the prevalence of probable neuropathic pain among adults with T2DM in primary care and to identify associated demographic, clinical and laboratory factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eCross-sectional study of adults aged 18\u0026ndash;65 years with T2DM duration\u0026thinsp;\u0026ge;\u0026thinsp;1 year registered at a family health centre in T\u0026uuml;rkiye. A stratified random sample of 400 patients was invited; 301 participated. Data were collected by interview and medical record review. Probable neuropathic pain was defined as the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) score\u0026thinsp;\u0026ge;\u0026thinsp;12. Associations were examined using multivariable logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants were 53.2% female; mean age 55.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7 years; median diabetes duration 120 months (interquartile range (IQR) 48\u0026ndash;180). The prevalence of probable neuropathic pain was 25.9% (95% confidence interval (CI) 21.1\u0026ndash;31.3). In the multivariable model, glycated haemoglobin (HbA1c)\u0026thinsp;\u0026ge;\u0026thinsp;9% (vs\u0026thinsp;\u0026lt;\u0026thinsp;7%; odds ratio (OR) 2.29, 95% CI 1.11\u0026ndash;4.75) and primary school or less education (vs university or higher; OR 3.04, 95% CI 1.01\u0026ndash;9.13) were independently associated with probable neuropathic pain.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAbout one in four working-age adults with T2DM in primary care reported probable neuropathic pain. Screening and education-tailored counselling, alongside intensified support for glycaemic control, may be particularly important for patients with poor glycaemic control and lower education.\u003c/p\u003e","manuscriptTitle":"Prevalence and associated factors of probable neuropathic pain among adults with type 2 diabetes in Turkish primary care: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 15:37:55","doi":"10.21203/rs.3.rs-8561163/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-17T16:00:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T09:47:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230783435483249228004717194585664347042","date":"2026-04-08T10:39:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81555715524301243223261989101489256923","date":"2026-04-07T08:15:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"22915320055101132747831264403834416737","date":"2026-03-03T19:08:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137024758023642305377296935647995326735","date":"2026-03-02T09:07:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-21T09:00:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95916541881983093822570937551917968904","date":"2026-02-11T03:37:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-29T08:12:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-21T15:28:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-19T09:52:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-16T21:02:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Primary Care","date":"2026-01-16T20:57:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-primary-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"famp","sideBox":"Learn more about [BMC Primary Care](https://bmcprimcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12875","title":"BMC Primary Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a075e52-9924-43a8-b8a8-69a1deb7b7b7","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T07:54:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 15:37:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8561163","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8561163","identity":"rs-8561163","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}