In a recent study from Singapore, housing type and sedentary behaviour have emerged as novel risk factors for diabetic peripheral neuropathy (DPN).
Analyses of data from two ongoing cohorts under the Singapore Population Health Studies (SPHS) showed that participants living in a ≥5-room flat had a 33-percent lower risk of DPN compared with those living in a four-room or smaller flat (hazard ratio [HR], 0.67, 95 percent confidence interval [CI], 0.48–0.94; p=0.020). [BMJ Public Health 2026;4:e004143]
Additionally, participants averaging at least 40.6 hours of sedentary time per week (a little less than 6 h per day) had a 54-percent greater risk of DPN than those who were less sedentary (HR, 1.54, 95 percent CI, 1.06–2.26; p=0.024).
Results also confirmed established clinical risk factors for DPN such as poor glycaemic control (HR, 1.23, 95 percent CI, 1.14–1.32; p<0.001), longer diabetes duration (every additional year: HR, 1.03, 95 percent CI, 1.02–1.05; p<0.001), obesity (HR, 1.04, 95 percent CI, 1.01–1.07; p=0.010), and older age (every additional year: HR, 1.06, 95 percent CI, 1.04–1.08; p<0.001).
Other significant predictors of DPN were the presence of cardiovascular disease (HR, 2.00, 95 percent CI, 1.37–2.93; p=0.009), lower systolic blood pressure (BP) levels (HR, 0.99, 95 percent CI, 0.98–1.00; p=0.004), and elevated diastolic BP levels (HR, 1.02, 95 percent CI, 1.01–1.03; p=0.002).
Social, lifestyle determinants
“To the best of our knowledge, this is the first study to investigate the role of social determinants in the development of DPN,” the authors said.
“A larger house size is an important indicator of higher socioeconomic status (SES) in Singapore. Conversely, residing in public rental housing is a marker of low SES, with those living in rental housing experiencing higher readmission risk, increased utilization of hospital services, higher mortality, and lower health-seeking behaviours,” they added.
The authors explained that for individuals in lower SES, exposure to factors such as poor diet either through being unable to access healthy food options or lack of knowledge, psychosocial stress, and limited physical activity opportunities may heighten the risk of DPN. “This association may also be mediated by adverse health behaviours, such as non-adherence to medication and the presence of concomitant comorbidities such as depressive symptoms.”
As for the role of sedentary behaviour in DPN development, evidence suggests the deterioration in cardiometabolic health and hyperglycaemia associated with increased sitting time or inactivity contribute to microvascular damage underlying the development of DPN. [BMC Public Health 2022;22:286; Biol Res Nurs 2016;18:160-166]
“Interestingly, physical activity was not significant in the multivariable analysis, suggesting that the negative effect of sedentary behaviour is independent of the benefits of physical activity. These results are relevant to the ‘active couch potato’ phenomenon, where individuals who are sufficiently physically active (eg, meet the requirements for purposeful physical exercise) are simultaneously highly sedentary (eg, also engage in long hours of work-related sitting),” the authors pointed out.
“Therefore, simply meeting the recommendation of purposeful exercise may not be sufficient in reducing DPN risk, but should be accompanied by a decrease in sedentary activities in general,” they added.
Target population
Overall, the present study underscores the importance of incorporating socioeconomic and sedentary behaviour indicators into DPN risk stratification to improve early identification of high-risk individuals, according to the authors.
“Public health and clinical interventions that focus on addressing social disadvantages and increasing general movement could help lower DPN incidence and its healthcare burden,” they said.
The study included 2,110 participants (mean age 57.1 years, 50.9 percent male, 46.1 percent Chinese) from the multiethnic cohort and diabetes cohort under the SPHS.
DPN occurred in 169 participants over a median follow-up of 3.69 years, with an incidence rate of 17.2 per 1,000 person-years.