Diabetic neuropathy: risk factors, prevalence and impact on quality of life: a systematic review

Diabetic neuropathy (DN) is among the most common and disabling complications of both type 1 and type 2 diabetes mellitus. It is associated with substantial morbidity, impaired quality of life, and increased mortality. Early diagnosis remains challenging, and many patients are identified only after irreversible nerve damage has occurred. The objectives of the study were: to determine the global prevalence of diabetic neuropathy, identify major risk factors associated with its development, and evaluate its impact on quality of life. A systematic search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception through March 2026. Studies reporting prevalence, risk factors, or quality-of-life outcomes of diabetic neuropathy were included. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment. Random-effects meta-analysis was used to estimate pooled prevalence, odds ratios (ORs), and standardized mean differences (SMDs). Heterogeneity was assessed using the I² statistic. Thirty-three studies involving over 150,000 individuals with diabetes were included. The pooled global prevalence of diabetic peripheral neuropathy was 38.5% (95% CI: 35.1–42.0%), with higher rates in developing countries. Significant risk factors included increasing age (OR: 1.04 per year; 95% CI: 1.03–1.05), poor glycemic control (HbA1c >7.0%; OR: 2.15; 95% CI: 1.89–2.45), and dyslipidemia (OR: 1.62; 95% CI: 1.37–1.91). Patients with diabetic neuropathy had significantly poorer quality of life, particularly in physical functioning domains (SMD: −0.78; 95% CI: −0.92 to −0.64). DN affects over one-third of individuals with diabetes and is strongly associated with modifiable risk factors and reduced quality of life.