Prevalence and associated factors of painful diabetic peripheral neuropathy among diabetic patients on follow up at Jimma University Medical Center



Despite having significant impact on the patient’s quality of life, painful diabetic peripheral neuropathy (PDPN) is usually underdiagnosed. Screening for PDPN in patients with diabetes is needed in order to get timely identification and management. Hence, the purpose of this study was to assess the prevalence and determinants of PDPN among diabetes patients attending outpatient at Jimma University Medical Center from September 1 November 10, 2019.


Hospital based cross-sectional study was conducted and douleur neuropathique-4 was used to identify the presence of PDPN. Data were collected using pretested structured questionnaire and entered into EPI data 3.1 and exported to SPSS version 20 for analysis. Both bivariate and multivariate binary logistic regression was employed to identify factors associated with PDPN. Variable having a p value of <0.25 in the bivariate model were considered as candidates for multivariable regression. Adjusted odds ratios were calculated at 95%CI and considered significant with a p value of <0.05.


A total of 366 diabetic patients were enrolled into the study and their mean duration of diabetes was 6.8 ± 5.3 years. The study finding showed that the prevalence of PDPN was 14.5%. According to the multivariate logistic regression analysis smoking [current smoker(AOR = 6.17; 95%CI:2.25,16.86),former smoker(AOR = 3.22;95%CI:1.29,8.03)],diabetes duration[5 to 10 years (AOR = 3.32;95%CI:1.29,8.53), ≥ 10 years (AOR = 8.86;95% CI: 3.49,22.5)] and comorbid hypertension [AOR = 2.54; 95%CI:1.17,5.49] were independent predictors of PDPN among study participants.


The overall prevalence of PDPN in this study was 14.5% and it was significantly associated with smoking, comorbid hypertension and diabetes duration of above 5 years. Early detection and appropriate interventions are important for high risk patients identified in the current study.

This is a preview of subscription content, log in to check access.



Adjusted odds ratio


Body mass index


Confidence interval


Crude odds ratio


Diabetes mellitus


Douleur Neuropathique-4


Diabetic peripheral neuropathy


Fasting blood sugar


Jimma University Medical Center




Painful diabetic peripheral neuropathy


  1. 1.

    Boulton AJ, Malik RA, Arezzo JC, Sosenko JM. Diabetic somatic neuropathies. Diabetes Care. 2004;27(6):1458–86.

    PubMed  Article  Google Scholar 

  2. 2.

    Veves A, Backonja M, Malik RA. Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options. Pain Med. 2008;9(6):660–74.

    PubMed  Article  Google Scholar 

  3. 3.

    Chong MS, Hester J. Diabetic painful neuropathy. Drugs. 2007;67(4):569–85.

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70(18):1630–5.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  5. 5.

    Tesfaye S, Vileikyte L, Rayman G, Sindrup SH, Perkins BA, Baconja M, et al. Toronto expert panel on diabetic neuropathy. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev. 2011;27(7):629–38.

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Bouhassira D, Letanoux M, Hartemann A. Chronic pain with neuropathic characteristics in diabetic patients: a French cross-sectional study. PLoS One. 2013;8(9).

  7. 7.

    Gordois A, Oglesby A, Scuffham P, Tobian JA, Shearer A. The health care costs of diabetic peripheral neuropathy in the US. Diabetes Care. 2003;26:1790–5.

    PubMed  Article  Google Scholar 

  8. 8.

    Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Res Clin Pract. 2000;47(2):123–8.

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Hartemann A, Attal N, Bouhassira D, Dumont I, Gin H, Jeanne S, et al. Working group on the diabetic foot from the French-speaking Society of Diabetology. Painful diabetic neuropathy: diagnosis and management. Diabetes Metab. 2011;37(5):377–88.

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Sadosky A, McDermott AM, Brandenburg NA, Strauss M. A review of the epidemiology of painful diabetic peripheral neuropathy, postherpetic neuralgia, and less commonly studied neuropathic pain conditions. Pain Practice. 2008;8(1):45–56.

    PubMed  Article  Google Scholar 

  11. 11.

    Van Acker K, Bouhassira D, De Bacquer D, Weiss S, Matthys K, Raemen H, et al. Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. Diabetes Metab. 2009;35(3):206–13.

    PubMed  Article  Google Scholar 

  12. 12.

    Goren A, Gross HJ, Fujii RK, Pandey A, Mould-Quevedo J. Prevalence of pain awareness, treatment, and associated health outcomes across different conditions in Brazil. Revista Dor. 2012;13(4):308–19.

    Article  Google Scholar 

  13. 13.

    Bohlega S, Alsaadi T, Amir A, Hosny H, Karawagh AM, Moulin D, et al. Guidelines for the pharmacological treatment of peripheral neuropathic pain: expert panel recommendations for the middle east region. J Int Med Res. 2010;38(2):295–317.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Taylor-Stokes G, Pike J, Sadosky A, Chandran A, Toelle T. Association of patient-rated severity with other outcomes in patients with painful diabetic peripheral neuropathy. Diabetes Metab Syndr Obes: Targets Ther. 2011;4:401.

    Google Scholar 

  15. 15.

    Aslam A, Singh J, Rajbhandari S. Prevalence of painful diabetic neuropathy using the self-completed Leeds assessment of neuropathic symptoms and signs questionnaire in a population with diabetes. Can J Diabetes. 2015;39(4):285–95.

    PubMed  Article  Google Scholar 

  16. 16.

    Jacovides A, Bogoshi M, Distiller LA, Mahgoub EY, Omar MK, Tarek IA, et al. An epidemiological study to assess the prevalence of diabetic peripheral neuropathic pain among adults with diabetes attending private and institutional outpatient clinics in South Africa. J Int Med Res. 2014;42(4):1018–28.

    PubMed  Article  Google Scholar 

  17. 17.

    Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the UK. Diabetes Care. 2011;34(10):2220–4.

    PubMed  PubMed Central  Article  Google Scholar 

  18. 18.

    Halawa MR, Karawagh A, Zeidan A, Mahmoud AE, Sakr M, Hegazy A. Painful diabetic peripheral neuropathy study group. Prevalence of painful diabetic peripheral neuropathy among patients suffering from diabetes mellitus in Saudi Arabia. Curr Med Res Opin. 2010;26(2):337–43.

    PubMed  Article  Google Scholar 

  19. 19.

    Ziegler D, Landgraf R, Lobmann R, Reiners K, Rett K, Schnell O, et al. Painful and painless neuropathies are distinct and largely undiagnosed entities in subjects participating in an educational initiative (PROTECT study). Diabetes Res Clin Pract. 2018;139:147–54.

    PubMed  Article  Google Scholar 

  20. 20.

    Riley L, Guthold R, Cowan M, Savin S, Bhatti L, Armstrong T, et al. The World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance: methods, challenges, and opportunities. Am J Public Health. 2016;106:74–8.

    PubMed  PubMed Central  Article  Google Scholar 

  21. 21.

    Spallone V, Morganti R, D’amato C, Greco C, Cacciotti L, Marfia GA. Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy. Diabet Med. 2012;29(5):578–85.

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Harifi G, Ouilki I, El Bouchti I, Ait Ouazar M, Belkhou A, Younsi R, et al. Validity and reliability of the Arabic adapted version of the DN4 questionnaire (Douleur Neuropathique 4 questions) for differential diagnosis of pain syndromes with a neuropathic or somatic component. Pain Practice. 2011;11(2):139–47.

    PubMed  Article  Google Scholar 

  23. 23.

    Juster-Switlyk K, Smith AG. Updates in diabetic peripheral neuropathy. F1000 Res. 2016;5.

  24. 24.

    Chahbi Z, Lahmar B, El Hadri S, Abainou L, Kaddouri S, Qacif H, Baizri H, Zyani M. The prevalence of painful diabetic neuropathy in 300 Moroccan diabetics. Pan African Med J 2018;31.

  25. 25.

    Erbas T, Ertas M, Yucel A, Keskinaslan A, Senocak M, TURNEP Study Group. Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients. J Clin Neurophysiol. 2011;28(1):51–5.

    PubMed  Article  Google Scholar 

  26. 26.

    Cortez J, Reis C, Cardoso Y, Onofre A, Piovezan AP. Prevalence of neuropathic pain and associated factors in diabetes mellitus type 2 patients seen in outpatient setting. Revista Dor. 2014;15(4):256–9.

    Article  Google Scholar 

  27. 27.

    Garoushi S, Johnson MI, Tashani OA. A cross-sectional study to estimate the point prevalence of painful diabetic neuropathy in eastern Libya. BMC Public Health. 2019;19(1):78.

    PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    Tsuji M, Yasuda T, Kaneto H, Matsuoka TA, Hirose T, Kawamori R, et al. Painful diabetic neuropathy in Japanese diabetic patients is common but underrecognized. Pain Res Treat. 2013;2013:1–3.

    Article  Google Scholar 

  29. 29.

    Yawn BP, Wollan PC, Weingarten TN, Watson JC, Hooten WM, Melton LJ III. The prevalence of neuropathic pain: clinical evaluation compared with screening tools in a community population. Pain Med. 2009;10(3):586–93.

    PubMed  PubMed Central  Article  Google Scholar 

  30. 30.

    Wu EQ, Borton J, Said G, Le TK, Monz B, Rosilio M, et al. Estimated prevalence of peripheral neuropathy and associated pain in adults with diabetes in France. Curr Med Res Opin. 2007;23(9):2035–42.

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Barbosa M, Saavedra A, Oliveira S, Reis L, Rodrigues F, Severo M, et al. Prevalence and determinants of painful and painless neuropathy in type 1 diabetes mellitus. Front Endocrinol. 2019;10:402.

    Article  Google Scholar 

  32. 32.

    Jambart S, Ammache Z, Haddad F, Younes A, Hassoun A, Abdalla K, et al. Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region. J Int Med Res. 2011;39(2):366–77.

    CAS  PubMed  Article  Google Scholar 

  33. 33.

    Ponirakis G, Elhadd T, Chinnaiyan S, Dabbous Z, Siddiqui M, Al-muhannadi H, et al. Prevalence and risk factors for painful diabetic neuropathy in secondary healthcare in Qatar. J Diab Investig. 2019;10(6):1558–64.

    Article  Google Scholar 

  34. 34.

    Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Pharmacol Ther. 2008;120(1):1–34.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  35. 35.

    Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, et al. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352(4):341–50.

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    AlQuliti K. Predictors of painful diabetic neuropathy in Saudi patients with type 2 diabetes. J Pain Relief. 2015;4:181.

    Google Scholar 

  37. 37.

    Kim SS, Won JC, Kwon HS, Kim CH, Lee JH, Park TS, et al. Prevalence and clinical implications of painful diabetic peripheral neuropathy in type 2 diabetes: results from a nationwide hospital-based study of diabetic neuropathy in Korea. Diabetes Res Clin Pract. 2014;103(3):522–9.

    PubMed  Article  Google Scholar 

  38. 38.

    De Visser A, Hemming A, Yang C, Zaver S, Dhaliwal R, Jawed Z, et al. The adjuvant effect of hypertension upon diabetic peripheral neuropathy in experimental type 2 diabetes. Neurobiol Dis. 2014;62:18–30.

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Miralles-García JM, de Pablos-Velasco P, Cabrerizo L, Pérez M, López-Gómez V. Sociedad Española de Endocrinología y Nutrición. Prevalence of distal diabetic polyneuropathy using quantitative sensory methods in a population with diabetes of more than 10 years’ disease duration. Endocrinol Nutr. 2010;57(9):414–20.

    PubMed  Article  Google Scholar 

  40. 40.

    Burke A, FitzGerald GA. Oxidative stress and smoking-induced vascular injury. Prog Cardiovasc Dis. 2003;46(1):79–90.

    CAS  PubMed  Article  Google Scholar 

Download references


I would like to acknowledge my study participants, data collectors and colleagues for their support. Lastly, I would like to thank Jimma University Medical Center staffs for providing me relevant information.


No funding was available for this work.

Author information



Corresponding author

Correspondence to Daba Abdissa.

Ethics declarations

Ethical approval and consent to participate

Ethical clearance was obtained from Jimma University Institutional Review Board. Oral informed consent was obtained from the study participants to start data collection. Information was recorded anonymously and their confidentiality was assured throughout the study period.

Competing interests

The authors of this study declare that has no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Abdissa, D. Prevalence and associated factors of painful diabetic peripheral neuropathy among diabetic patients on follow up at Jimma University Medical Center. J Diabetes Metab Disord (2020).

Download citation


  • Neuropathic pain
  • Prevalence
  • Factors
  • Jimma University medical center