Severe insulin-deficient diabetes is at the opposite end of the neuropathy spectrum to mild aged-related diabetes.

The effect of diabetes subtypes on neuropathy prevalence and metabolic drivers of this relationship are unknown. Using electronic medical records from 50 diabetes care centers in eight states of India with biothesiometer and complete phenotyping data on 22,348 patients, we determined neuropathy prevalence stratified by India-specific diabetes subtypes and evaluated associations with neuropathy (biothesiometer). Neuropathy prevalence was highest in severe insulin-deficient diabetes (SIDD; 25.5%), followed by insulin-resistant obese diabetes (IROD; 21.8%), mild age-related diabetes (MARD; 18.9%), and combined insulin-resistant and deficient diabetes (CIRDD; 17.3%, P = <0.001). HbA1c (odds ratio [OR]: 1.19, 1.16-1.21), diabetes duration (OR: 1.04, 1.04-1.05), and waist circumference (OR: 1.01, 1.01-1.02) were associated with neuropathy. SIDD (OR: 2.23, 2.01-2.47), CIRDD (OR: 1.89, 1.69-2.11), and IROD (OR: 1.84, 1.66-2.04) had increased neuropathy compared to MARD. In India, SIDD patients are more likely to have neuropathy compared to MARD patients likely from longer diabetes duration and higher HbA1c; therefore, interventions should focus on hyperglycemia. Interventions in CIRDD and IROD patients should likely address obesity as well.