Diabetic Peripheral Neuropathy (DPN) is one of the most prevalent and debilitating complications of diabetes mellitus, affecting an estimated 50% of all diabetic patients over their lifetime. In Pakistan — which has the third-highest number of diabetic patients in the world — DPN represents a massive, underdiagnosed public health crisis.
According to the International Diabetes Federation (IDF) Diabetes Atlas 2023, Pakistan has approximately 33 million people living with diabetes, with millions more undiagnosed. The prevalence rate stands at roughly 30.8% among adults aged 20–79 — among the highest in the world. Punjab and Sindh are the most affected provinces, with urban populations showing consistently higher rates than rural areas.
With such a massive diabetic population, the downstream burden of DPN is staggering. Conservative estimates suggest that at least 15–20 million Pakistanis currently have some degree of diabetic peripheral neuropathy, the majority of whom remain undiagnosed.
DPN is damage to the peripheral nerves — the network of nerves outside the brain and spinal cord — caused by prolonged hyperglycemia (high blood sugar). It primarily affects the feet and legs (in a "glove and stocking" distribution), causing:
Left untreated, DPN is the leading cause of diabetic foot ulcers and the primary driver of lower-limb amputations in Pakistan. The social and economic cost is immense.
Several factors contribute to the high rate of missed diagnoses:
The most widely available method. A 10-gram monofilament is applied to specific foot sites to assess protective sensation. While inexpensive, it only tests one aspect of nerve function (pressure sensation) and has poor sensitivity for early-stage DPN.
Using a biothesiometer or tuning fork, VPT testing measures the minimum vibration stimulus perceptible by the patient. Elevated VPT is strongly associated with future foot ulceration risk. Available at selected tertiary care hospitals in Lahore, Karachi, and Islamabad.
Gold standard for DPN diagnosis. Electromyography (EMG/NCV) labs measure electrical conduction speed in peripheral nerves. Highly accurate but expensive, time-consuming, and only available at major hospitals — creating a significant access gap for most Pakistani patients.
Assesses small-fiber nerve function (C-fibers and A-delta fibers) by measuring the minimum temperature change the patient can detect. Early small-fiber neuropathy often precedes large-fiber damage detectable by NCV.
Modern devices like the Diabe-Neurosense by Biomedionics combine vibration threshold, thermal sensitivity, and nerve conduction assessments in a single portable clinical device. This makes comprehensive DPN screening accessible at the clinic or even community level — without requiring a hospital NCV lab.
The Diabe-Neurosense provides AI-powered, multi-modal neuropathy screening in under 10 minutes. Designed for Pakistani clinics. PKR 90,000.
View Diabe-Neurosense →Based on international guidelines (ADA 2024, NICE) and local Pakistan Endocrine Society (PSES) recommendations, the following screening protocol is advised:
A single below-knee amputation in Pakistan costs between PKR 200,000–500,000 in surgical fees alone, followed by years of rehabilitation costs. In contrast, comprehensive DPN screening with a device like Diabe-Neurosense costs under PKR 1,000 per test (amortized device cost). Early detection and intervention prevent foot ulcers — the primary pathway to amputation.
Diabetic peripheral neuropathy in Pakistan is a silent epidemic. With 33 million diabetics and over half eventually developing DPN, the need for accessible, affordable, and accurate screening tools has never been greater. Modern multi-modal diagnostic devices are changing what is possible even at the primary care level — bringing nerve function testing out of tertiary hospital labs and into community clinics across Pakistan.