Association between physical activity and peripheral neuropathy among patients with diabetes mellitus: A cross-sectional study

Background Diabetic peripheral neuropathy (DPN) is a frequent and disabling complication of diabetes mellitus that impairs function, increases morbidity, and predisposes to orthopedic complications. Its relationship with physical activity in community dwelling patients with diabetes remains unclear, particularly in high burden settings such as Saudi Arabia. Objective To examine the association between physical activity level and reported peripheral neuropathy among adults with diabetes mellitus in the Northern Border Region of Saudi Arabia. Methods A descriptive cross sectional study was conducted between November 2025 and February 2026 using an anonymous online questionnaire disseminated via social media. Adults aged ≥18 years with type 1 or type 2 diabetes residing in the Northern Border Region were eligible. Peripheral neuropathy was assessed using the Diabetic Neuropathy Symptom score, and physical activity was measured using the International Physical Activity Questionnaire–Short Form. Participants were categorized into low, moderate, and high physical activity levels based on MET minutes/week. Associations were examined using chi square tests and multivariable logistic regression, adjusting for demographic and clinical covariates, including metformin use and glycemic control. Results A total of 463 participants were analyzed; the prevalence of peripheral neuropathy was 78.6%. Neuropathy prevalence increased across physical activity levels (low: 66.7%; moderate: 78.2%; high: 84.3%; p = 0.040). High physical activity was associated with greater odds of neuropathy versus low activity (adjusted odds ratio 2.47, 95% confidence interval 1.07–5.70, p = 0.034). Metformin use was also independently associated with neuropathy. Conclusion DPN was highly prevalent in this cohort. High physical activity and metformin use were independently associated with neuropathy, underscoring the need for neuropathy screening, individualized activity counseling, and consideration of vitamin B12 monitoring in metformin treated patients.