In the clinical management of type 2 diabetes, success is too often measured solely by glucose monitors and HbA1c percentages. Yet, for the patient sitting in the consultation room, diabetes is measured by their daily lived experience. Among the most taxing complications they face is Diabetic Peripheral Neuropathy (DPN)—a condition where the body’s longest nerve fibres slowly degrade due to sustained hyperglycemia and microvascular damage.

For the person enduring it, DPN is terrifying. It strips away the protective sensation of touch and replaces it with relentless burning, electric shocks, or a profound, heavy numbness. In coastal areas like Puri, where many individuals rely on intense physical labour, farming, or long hours of walking for their livelihoods, the health of one's feet is intrinsically tied to one's independence. A lost sensation can easily turn an unnoticed blister into a life-threatening ulcer.

Despite a wealth of research on diabetes in metropolitan India, localized studies focusing on both the clinical statistics and the human burden of DPN in tier-two cities and rural peripheries remain scarce. This study, conducted at SJ Medical College and Hospital (2023–2024), aims to map the prevalence and risk factors of DPN in a cohort of 160 patients. By pairing rigorous statistical validation with a genuine inquiry into how these patients sleep, move, and feel, we seek to advocate for a more holistic, empathetic standard of diabetic care.

2.1 Study Setting and Design This hospital-based, cross-sectional observational study was conducted in the Department of General Medicine at SJ Medical College and Hospital, Puri, Odisha. Data collection spanned 24 months, from January 2023 through December 2024. 2.2 Study Population The sample comprised 160 adult patients diagnosed with T2DM. • Inclusion Criteria: Adults aged 35 to 75 years who had been living with a confirmed diagnosis of T2DM for at least one year and were willing to participate in detailed clinical and lifestyle assessments. • Exclusion Criteria: Patients suffering from neuropathy due to alternative causes (e.g., severe vitamin B12 deficiency, chronic alcoholism, or hypothyroidism), those with active, severe diabetic foot ulcers, and individuals with a history of lower-limb amputation. 2.3 Clinical and Empathetic Assessment 1. Clinical Evaluation: DPN was diagnosed using the validated Michigan Neuropathy Screening Instrument (MNSI). This physical examination assessed vibration perception (using a 128 Hz tuning fork), ankle reflexes, and tactile sensitivity via the 10g Semmes-Weinstein monofilament test. 2. Patient-Centered Interviews: We moved beyond the physical exam to ask patients about the quality of their pain, their sleep hygiene, and how their foot health impacted their emotional well-being and daily routines. 2.4 Statistical Analysis Data were analysed using SPSS version 26.0. Continuous variables were expressed as mean ± standard deviation (SD) and evaluated via the independent Student’s t-test. Categorical variables were assessed using the Chi-square test. A p-value of < 0.05 was considered statistically significant. 2.5 Ethical Considerations The study protocol received full clearance from the Institutional Ethics Committee of SJ Medical College. Informed consent was obtained from all participants, ensuring their narratives and medical data were treated with the utmost respect and confidentiality.

3.1 Patient Journey Flowchart

[Initial OPD Screening: 198 T2DM Patients Assessed]

       [Excluded: 38 Patients]

• Neuropathy from non-diabetic causes (e.g., B12 deficiency, alcohol): 18
• Presence of active severe foot ulcers / prior amputation: 11
• Declined consent or incomplete lab data: 9

[Final Enrolled Study Cohort: 160 Patients]

        Underwent MNSI Examination, HbA1c Testing, & Lifestyle Interviews

• Diagnosed with DPN: 76 (47.5%)
• Negative for DPN: 84 (52.5%)

3.2 Baseline Demographics

The demographic breakdown reveals that the burden of DPN falls heavily on older individuals. Age and body mass index showed statistically significant differences between the two groups, underscoring the compounding nature of metabolic wear and tear.

Table 1: Baseline Demographic and Clinical Characteristics (N = 160)

3.3 The Timeline of Nerve Damage

Time is a relentless adversary for the diabetic nerve. Our statistical analysis demonstrated a striking escalation in neuropathy prevalence as patients crossed the five- and ten-year thresholds of living with the disease.

Table 2: Association Between Duration of Diabetes and DPN Prevalence

3.4 Glycemic Control (HbA1c)

HbA1c provides a historical record of a patient's metabolic control. The correlation between unmanaged blood sugar and the destruction of peripheral nerves is profound and highly significant.

Table 3: Glycemic Control Status and Incidence of DPN

3.5 Systemic Comorbidities

Diabetes rarely damages just one system. We observed that patients who had developed peripheral neuropathy were statistically far more likely to also suffer from retinopathy and hypertension, confirming the systemic nature of microvascular decay.

Table 4: Comorbidities Associated with DPN

3.6 The Human Experience: Symptoms and Quality of Life

Clinical diagnostics cannot quantify exhaustion or fear. We asked patients to describe their pain and how it altered their daily lives. The differences in quality of life between those with and without DPN were stark and highly significant. (Note: Patients could report more than one symptom).

Table 5: Impact of Neuropathy on Daily Functioning and Mental Well-being

The clinical data gathered at SJ Medical College between 2023 and 2024 reveals a sobering reality: nearly half (47.5%) of the surveyed diabetic population in Puri is enduring the daily burden of peripheral neuropathy. This prevalence aligns with the upper limits of several pan-Indian epidemiological estimates, indicating a severe localized challenge in managing chronic diabetic complications.

Statistically, the development of DPN is unequivocally tied to disease duration (p < 0.001) and glycemic control (p < 0.001). A patient living with diabetes for over a decade, struggling to keep their HbA1c below 8.0%, carries a 74.1% risk of developing irreversible nerve damage. Furthermore, the significant association between DPN and diabetic retinopathy (OR 4.86, p < 0.001) serves as a vital clinical warning: when the nerves in the feet begin to fail, the microvasculature of the eye is likely failing as well.

However, the most compelling and urgent findings of this study lie in Table 5. The highly significant p-values (p < 0.001) regarding sleep fragmentation and mobility-related anxiety illustrate that DPN is not merely a physical ailment; it is a profound psychological trauma. Over 72% of the DPN cohort reported severe nocturnal burning. Sleep deprivation exacerbates insulin resistance, destroys mood, and severely limits a patient's capacity to engage in the lifestyle changes necessary to manage their diabetes. Additionally, the silent terror of losing a limb—reported by 46% of DPN patients—is a heavy, isolating weight.

As healthcare providers, these statistics demand a shift in our clinical paradigm. A p-value of < 0.001 for glycemic control must not just prompt an increase in insulin dosage; it must prompt a physical examination of the patient's feet and an empathetic conversation about their pain.

Limitations

This cross-sectional study captures a single moment in time and cannot definitively establish causation. The cohort, sourced from a tertiary medical college, may lean toward patients who actively sought hospital-level care for symptomatic relief, potentially underrepresenting the silent, early stages of nerve damage in the wider rural community.

Diabetic Peripheral Neuropathy remains a widespread and devastating complication among patients at SJ Medical College, Puri. Driven by prolonged disease duration and suboptimal blood sugar control, it silently compromises the mobility, sleep, and emotional stability of nearly half of the diabetic cohort. The strong statistical evidence presented here is a call to action: modern diabetes care must be intrinsically holistic. Routine, empathetic foot examinations must become an absolute standard of care, ensuring we protect not just our patients' limbs, but their dignity and quality of life.

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