Neutrophil-to-Lymphocyte Ratio, Lipid Profile, and Diabetic Peripheral Neuropathy Risk: Mediation and Synergy in a Community-Based Cross-Sectional Study.

Diabetic peripheral neuropathy (DPN) remains under-detected in primary care despite available bedside tests and laboratory markers. We assessed whether lipid profile components mediate and synergize with systemic inflammation, indexed by the neutrophil-to-lymphocyte ratio (NLR), in relation to DPN. In a cross-sectional study in Indonesia (July 2023-January 2024), 738 participants completed questionnaires, laboratory testing, and sensory screening with a 10-g Semmes-Weinstein monofilament and 128-Hz tuning fork. Multivariate logistic regression showed that an abnormally increased NLR (AOR 8.39; p < 0.001), total cholesterol (AOR 3.10; p < 0.001) and LDL-C (AOR 2.25; p < 0.001) were independently associated with a higher DPN risk. Combined abnormalities markedly amplified the risk (AOR 33.30; p < 0.001). Path analysis supported partial mediation of the NLR-DPN association via LDL-C and total cholesterol (total indirect β = 0.03; 95% CI 0.02-0.05; p < 0.001). Integrating NLR and lipid monitoring with routine foot screening in nurse-led primary care may enable earlier identification and risk stratification, particularly among individuals with longer duration or suboptimal glycemic control, thereby supporting targeted education and prevention to reduce disability and advance diabetes care.