Neuropathy and Quality of Life in Diabetes
Danique Mocking, Sabita S. Soedamah-Muthu, Giesje Nefs, Elizabeth Holmes-Truscott, Marjolein M. Iversen, Loretta Vileikyte, Christophe De Block, Mariska Bot, Patrick Vriens and Frans Pouwer
The associations between different types of diabetes neuropathy symptoms and neuropathy-specific quality of life: Results from the diabetes MILES the Netherlands study.Journal of Diabetes and Its Complications. 2026 Sep 1;40(11):109398.
Diabetes neuropathy (DN) is a common complication of both type 1 diabetes (T1D) and type 2 diabetes (T2D). It can cause a wide range of symptoms, including pain, reduced sensitivity, weakness and problems with balance. Previous research has shown that neuropathy can negatively affect quality of life, but less is known about whether different types of neuropathy symptoms have a different impact.
This study therefore investigated the association between different types of DN symptoms and neuropathy-specific quality of life (NS-QoL). The researchers used data from 1,324 adults participating in the Diabetes MILES – The Netherlands study: 583 with T1D and 741 with T2D. Participants were classified into five groups according to their self-reported symptoms: pain, reduced sensitivity, diffuse sensory-motor symptoms, multiple types of symptoms, or no symptoms.
Key findings:
- Having neuropathy symptoms was associated with lower quality of life: In people with T1D, pain, reduced sensitivity and diffuse sensory-motor symptoms were all associated with significantly lower NS-QoL compared with having no symptoms. A broadly similar pattern was observed in T2D, although reduced sensitivity alone did not differ significantly from having no symptoms.
- Having multiple types of symptoms had the greatest impact: In both T1D and T2D, participants experiencing multiple types of neuropathy symptoms reported the lowest NS-QoL. The findings suggest that the overall burden of symptoms may be particularly important for how neuropathy affects daily life.
- No single symptom type consistently stood out as having a greater impact: Although the symptom groups differed substantially from people without symptoms, pain, reduced sensitivity and diffuse sensory-motor symptoms did not significantly differ from each other in their association with NS-QoL.
- Other factors were also associated with quality of life: Among people with T1D, more diabetes complications, older age and higher BMI were associated with lower NS-QoL. Among those with T2D, more complications, higher anxiety levels and male sex were associated with lower NS-QoL.
- Reduced sensitivity deserves particular clinical attention: Symptoms such as loss of sensation may feel less disruptive than pain, but can still indicate clinically important neuropathy. Loss of protective sensation can increase the risk of unnoticed injuries, foot ulcers, impaired balance and falls. This means that a relatively low perceived symptom burden does not necessarily indicate a low clinical risk.
The findings highlight the potential value of looking beyond the presence or absence of neuropathy and asking which symptoms a person experiences and how these affect their life. Different symptom profiles may call for different approaches: people experiencing pain may benefit from optimised pain management and psychological support, while those with reduced sensitivity may particularly benefit from regular foot screening, preventive foot care and education. For people with sensory-motor symptoms, interventions targeting balance, mobility and fall prevention may be especially relevant.
The study also has important limitations. Because it was cross-sectional, it cannot establish cause and effect. Neuropathy symptoms were self-reported rather than established through objective neurological testing, and the authors caution that the clinical significance of differences in NS-QoL scores remains uncertain. The findings should therefore primarily be considered hypothesis-generating.
Concluding, the authors state
“...the findings of this study indicate that all types of DN symptoms contribute meaningfully to NS-QoL.”
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