ArticleActa diabetologica2026
Symptom-driven co-existence of diabetic autonomic neuropathy, peripheral neuropathy, and painful neuropathy.
Article in Acta diabetologica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsDiabetic Autonomic Neuropathy (DAN) and Diabetic Peripheral Neuropathy (DPN) are distinct complications of diabetes, but their co-existence remains underexplored. This study aimed to investigate the symptom-driven co-existence of DAN, DPN, and painful DPN.
methodsIn November 2022, an electronic survey was distributed to everyone with diabetes in the North Denmark Region (n = 29,155). The survey included demographic data, and validated questionnaires: the Michigan Neuropathy Screening Instrument (MNSI), Composite Autonomic Symptom Score-31 (COMPASS-31), and Douleur Neuropathique 4 Interview (DN4i). DPN was defined as MNSI ≥ 4, painful DPN as bilateral foot pain with DN4i ≥ 3, and DAN as COMPASS-31 ≥ 16. DAN was further stratified into: symptoms of autonomic dysfunction (SAD)- (< 16), SAD + (16-31), and SAD + + (≥ 32).
resultsOf 9,913 respondents, 7,321 provided complete data. Mean age was 64.8 yearsand 86.3% had type 2 diabetes. DPN prevalence among those with DAN was 44.6% in type 1 and 39.6% in type 2 diabetes. DPN prevalence rose with DAN severity: 11.1% in SAD-, 26.4% in SAD + , and 58.6% in SAD + + (p < 0.01). Painful DPN followed a similar trend, increasing from 8.0% in SAD- to 50.2% in SAD + + (p < 0.01). Linear regression demonstrated a strong association between COMPASS-31 and MNSI scores (p < 0.001), indicating that higher autonomic symptom burden was associated with greater severity of peripheral neuropathy.
conclusionsDAN, DPN, and painful DPN frequently co-exist. Increasing DAN symptom severity is associated with higher prevalence of both DPN and neuropathic pain and showed a strong linear association with the severity of peripheral DPN, suggesting shared pathophysiological mechanisms beyond isolated small fiber involvement.
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