Interventions to Prevent and Reduce Diabetic Peripheral Neuropathy Complications in PHCs: A Systematic Review

Background: Diabetic peripheral neuropathy (DPN) affects up to half of people with diabetes and is the principal pathway to foot ulceration, falls and amputation. Most people with type 2 diabetes in Saudi Arabia are managed in primary health care centres (PHCs), where painful DPN affects about one-third of patients and is frequently unrecognised. Objective: To systematically identify, appraise and synthesise evidence on interventions delivered in, or deliverable through, primary health care to prevent the onset or progression of DPN or reduce its complications in adults with diabetes. Methods: PubMed/MEDLINE was searched on 21 October 2026 (1 January 2000 to 20 October 2026) using a primary-care trials strategy and a Saudi/Middle East strategy, supplemented by PubMed Central, Google Scholar and ResearchGate. Eligible studies were randomised and non-randomised intervention studies in primary care, community, home-based or ambulatory settings. Two reviewers independently screened records and appraised full texts. Risk of bias was judged with RoB 2 or ROBINS-I. Findings were synthesised without meta-analysis (SWiM) across seven intervention domains, and certainty was graded with GRADE. Results: Of 195 unique records, 42 studies (44 reports; 30 randomised trials) from 17 countries were included. Education and self-management dominated (18 studies) and improved foot-care knowledge or behaviour in 16. Only one education trial reported ulcers (0 vs 8%). Early multifactorial treatment of screen-detected type 2 diabetes in general practice did not reduce neuropathy at 5 years (OR 0.95, 95% CI 0.68–1.34). Exercise was safe and improved balance and function but did not reduce ulceration. Quality-improvement programmes increased foot examination rates (e.g., OR 1.33, 95% CI 1.05–1.69). Symptom- management trials were small and mixed. Risk of bias was high in 20 studies, with some concerns in 17 and low in 5. Only two Saudi studies were found, both uncontrolled. Certainty was low to very low for clinical outcomes. Conclusions: Primary-care interventions reliably improve foot-care knowledge, behaviour and processes of care, but evidence that they prevent DPN, ulceration or amputation is sparse and of low certainty. Saudi PHCs should embed risk-stratified foot screening, multi-component education, exercise prescription and audit within a national pathway, alongside pragmatic trials with clinical end-points.