Diabetic Autonomic Neuropathy Among Patients With Diabetes in Rural Warangal in India: A Cross-Sectional Study.

Background Diabetic autonomic neuropathy (DAN) is a common but frequently underdiagnosed complication of diabetes mellitus that affects multiple organ systems and contributes to increased morbidity and mortality. Early identification using simple screening tools is essential, particularly in resource-limited primary care settings. However, community-based data on DAN from rural India remain limited. Objectives The objective of this study is to estimate the proportion of screen-positive DAN and identify factors associated with its occurrence among individuals with type 2 diabetes mellitus in rural Warangal, Telangana. Methods A community-based cross-sectional study was conducted among 400 adults aged ≥30 years with previously diagnosed type 2 diabetes mellitus residing in the rural field practice area of Kakatiya Medical College, Warangal, during 2020-2021. Participants were selected through simple random sampling from the Non-Communicable Disease (NCD) register. Data were collected using a pre-tested semi-structured questionnaire. DAN was screened using the validated Composite Autonomic Symptom Score (COMPASS-31), with a score ≥17 indicating DAN. Descriptive statistics, binary logistic regression, and multivariable logistic regression analyses were performed to identify independent predictors. A p-value <0.05 was considered statistically significant. Results The prevalence of diabetic autonomic neuropathy was 21.0% (84/400). On multivariable logistic regression analysis, younger age (≤44 years) (adjusted odds ratio (AOR): 3.10), female sex (AOR: 1.72), illiteracy (AOR: 1.85), unemployment (AOR: 1.67), smoking (AOR: 7.95), alcohol consumption (AOR: 5.21), inadequate daily vegetable intake (AOR: 1.64), physical inactivity (AOR: 1.72), and poor glycaemic control (random blood glucose ≥200 mg/dL; AOR: 6.03) were identified as significant independent factors associated with DAN (p<0.05). Conclusion Approximately one in five individuals with type 2 diabetes in this rural population had DAN. Lifestyle-related factors, poor glycaemic control, and adverse socioeconomic characteristics were independently associated with DAN. Community-based screening using validated symptom-based tools such as COMPASS-31, along with interventions promoting glycaemic control and healthy lifestyle practices, may facilitate early detection and reduce the burden of diabetic complications in rural settings.