Role of social determinants, lifestyle and clinical factors in the development of diabetic peripheral neuropathy among a multiethnic Asian population in Singapore: a retrospective analysis

Introduction Diabetic peripheral neuropathy (DPN) is a common, underdiagnosed and irreversible complication of diabetes mellitus. However, limited evidence exists on the drivers of DPN in Asian populations, particularly the role of social and lifestyle factors. This study aimed to identify sociodemographic, lifestyle and clinical predictors of incident DPN in a multiethnic Asian cohort in Singapore.Methods Data from two ongoing Singaporean cohorts were analysed. Participants included individuals with type 2 diabetes mellitus and no DPN at baseline. DPN was assessed at follow-up using self-report, neurothesiometer testing or monofilament scores. Bivariate and multivariate Cox regression analyses were conducted to examine the association between incident DPN and various sociodemographic, lifestyle and clinical factors.Results During a median follow-up of 3.69 years, 169 out of 2110 participants developed DPN. Multivariable analysis revealed age (HR 1.06, 95% CI 1.04 to 1.08, p<0.001), sedentary time (HR 1.54, 95% CI 1.06 to 2.26, p=0.018), housing (HR 0.67 for larger flats, 95% CI 0.48 to 0.94, p=0.020), HbA1c (HR 1.23, 95% CI 1.14 to 1.32, p<0.001), diabetes duration (HR 1.03, 95% CI 1.02 to 1.05, p<0.001), body mass index (HR 1.04, 95% CI 1.01 to 1.07, p=0.010), systolic (HR 0.99, 95% CI 0.98 to 1.00, p=0.004) and diastolic blood pressure (HR 1.02, 95% CI 1.01 to 1.03, p=0.002) and cardiovascular disease (HR 2.00, 95% CI 1.37 to 2.93, p =0.009) to be independently associated with incident DPN.Conclusions This study confirms established risk factors for DPN and highlights housing type and sedentary behaviour as novel, potentially modifiable predictors. These findings underscore the importance of targeting high-risk groups and addressing modifiable risk factors to reduce the burden of DPN in Asian populations.