Neuropathy Unplugged-hematological and Electrophysiological Predictors of Peripheral Neuropathy in Type 2 Diabetes Mellitus

Background and Aim: Diabetic peripheral neuropathy (DPN) is a debilitating complication of type 2 diabetes mellitus (T2DM), characterized by neuroinflammation due to prolonged hyperglycemia. This study aimed to develop a predictor-based model using hematological and electrophysiological variables to predict DPN in T2DM. Materials and Methods: A cross-sectional study was conducted with 30 diagnosed T2DM patients and 30 healthy participants. Data collected included demographic information, laboratory findings, nerve conduction studies, and Ewing’s battery of autonomic function tests. Multivariate-adjusted Cox regression analysis assessed the association of various predictors with DPN. Results: Diabetic patients exhibited higher glycated hemoglobin (HbA1c), random blood sugar (RBS) ( P < 0.001), higher prevalence of smoking, hypertension, and hyperlipidemia compared to healthy controls. DPN was present in 73.3% of diabetic patients. Diabetics had lower platelet and red blood cell (RBC) but higher basophil count, platelet-larger cell ratio (P-LCR) and mean platelet volume ( P < 0.0001). Electrophysiological assessments revealed decreased nerve conduction amplitude, velocity, latency ( P < 0.001), and impaired autonomic function ( P < 0.0007). Independent predictors had following cut-off points: HbA1c >5.85%, RBS >123.5 mg/dL, basophil >0.05%, RBC <4.87 million/mm 3 , P-LCR >48.75%, right tibial motor nerve amplitude <9.20 mV, left ulnar motor nerve amplitude <10.55 mV, delta heart rate <16.5 beats/min, expiration: inspiration ratio <1.18, root mean square of successive R-R interval differences <20.21 ms and standard deviation of normal-to-normal R-R intervals <20.55 ms. Using the cutoff points the predictor-based model demonstrated robust predictive capability for DPN (area under receiver operating curve: 0.809, Positive predictive value (PPV): 72.73%, Negative predictive value (NPV): 72.73%, P < 0.0004). Conclusion: Elevated HbA1c, RBS, P-LCR, basophils, decreased RBC count, and declining electrophysiological responses were significant independent predictors of DPN, demonstrating the potential to predict its occurrence in diabetes mellitus patients.