Associations Between Diabetes Distress, Diabetic Peripheral Neuropathy and Neuropathic Pain in People With Type 2 Diabetes—The Maastricht Study

BACKGROUND AND AIMS: Diabetic peripheral neuropathy (DPN) and neuropathic pain are associated with various psychosocial factors, but the effect of diabetes distress remains underexplored. This study examines the associations between diabetes distress, DPN, and neuropathic pain. METHODS: A cross-sectional analysis on participants with type 2 diabetes from The Maastricht Study was conducted. Diabetes distress was assessed with the PAID-20 questionnaire and categorized as low (score < 16), moderate (score 17-39), and high (score ≥ 40). Neuropathic pain was measured with the DN4 questionnaire, while DPN was clinically assessed through vibration perception threshold. Logistic regression analyses on the outcomes DPN only, neuropathic pain, and both DPN and pain were conducted, adjusted for sociodemographic (age, sex, education) and clinical characteristics (insulin use, HbA1c, depression). RESULTS: 1418 participants were included (median age: 64 years, 68.4% male). Moderate and high diabetes distress were observed in 22.5% and 4.8% of participants. Moderate (adjusted OR: 1.95; 95% CI: 1.37-2.75) and high distress (adjusted OR: 3.64; 95% CI: 1.97-6.63) were associated with the presence of neuropathic pain, but not with DPN alone. INTERPRETATION: Diabetes distress is strongly associated with neuropathic pain but not with DPN. These findings suggest that individuals with neuropathic pain may benefit from psychosocial screening and support.