A subset of patients with diabetic polyneuropathy (DPN) have significant pain. There is little information on how patients with painful diabetic polyneuropathy (DPN+P) differ from those with DPN without pain (DPN-P). The objective was to determine differences in demographics, socioeconomic characteristics, and patient-reported quality-of-life (QoL) between DPN+P and DPN-P patients. We used an algorithm of high sensitivity (90%) and moderate specificity (60%) to electronically classify patients within our institution between 2009 and 2016 as no DPN, DPN+P, or DPN-P. QoL was assessed as part of standard of care using PROMIS Global Health mental and physical summary scores, and PHQ-9 depression screen. We report clinically and statistically significant (p<0.05) differences between DPN+P and DPN-P. Independent associations with DPN+P were evaluated using multivariable logistic regression models.Of 43,945 patients with type 2 diabetes, 13,910 (32%) had DPN, of whom 9,104 patients had DPN+P (65%) and 4,806 had DPN-P (35%). Patients with DPN+P were significantly younger than DPN-P (68±13 vs. 66±13), and more likely to be female (55% vs. 44%). Compared to DPN-P, DPN+P patients were less frequently white (67% vs. 72%), less frequently married (47% vs. 54%), had lower median household income ($50.6k vs. $55.5k), and were more likely to be covered by Medicaid (14% vs. 7%) and less likely to have private health insurance (21% vs. 29%). QoL measures, PROMIS and PHQ-9 scores, were significantly worse for patients with DPN+P vs. DPN-P. Younger age, female sex, and worse QoL remained independently associated with DPN+P after adjustment. Demographic, socioeconomic, and QoL associations could be causative of pain, perhaps mediated through poorer diabetes care, and could be consequences of pain, mediated through loss of productivity. This reciprocal effect and the economic magnitude of the problem warrant longitudinal study of the risk factors and natural history of pain in DPN.
B. Lapin: None. S. Morrison: None. A. Schuster: None. K. Johnson: Employee; Self; Novartis Pharmaceuticals Corporation. F. Boulos: Employee; Self; Novartis Pharmaceuticals Corporation. N.J. Thakore: Research Support; Self; Novartis Pharmaceuticals Corporation. A. Milinovich: Research Support; Self; Amgen Inc., Celgene Corporation, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Otsuka Pharmaceutical Co., Ltd.