Practices and attitudes of Thai community pharmacists in managing diabetic peripheral neuropathy using neurotropic B vitamins.

Background: Diabetic peripheral neuropathy (DPN) affects approximately half of individuals with diabetes. Community pharmacists play a pivotal role in the early management of DPN. This exploratory study examined community pharmacist practices in DPN assessment and management, with particular focus on attitudes toward and factors influencing neurotropic B vitamin recommendations. Methods: A cross-sectional survey was conducted among a convenience sample of community pharmacists in Bangkok, Thailand. The questionnaire focused on pharmacists' attitudes and practices in managing patients presenting with negative symptoms, positive symptoms, or diagnosed DPN. Results: Ninety community pharmacists participated in this study. Most patients presented with mild symptoms. Symptom severity was primarily assessed based on patient history and pain scales. Among patients presenting with negative symptoms and overt DPN, the most frequently recommended medication was a combined neurotropic B vitamin (48.11% and 44.73%, respectively). The factor associated with likelihood of recommending combined neurotropic B vitamins was reasonable product price, while guideline recommendation, package labelling, and brand reputation showed inverse association with recommendation behaviour. Conclusion: Community pharmacists frequently recommend neurotropic B vitamins for early-stage and painless DPN - presentations not addressed in current clinical guidelines. The inverse associations between guideline endorsement and recommendation behaviour likely reflect these guideline gaps rather than inappropriate practice. Pharmacy-specific clinical guidelines and clearer product labelling addressing both painful and painless DPN are needed. Given the exploratory design and convenience sampling from Bangkok, findings should be interpreted as hypothesis-generating.