JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v7i1.2603 jpsim.v7i1.2603 Original Research Knowledge, Attitudes, and Screening Practices for Diabetic Neuropathy Among General Practitioners: A Cross-Sectional Study in Pakistan Masud Mohsin Bangash Lala Rukh lala_bangash@yahoo.com * Department of Medicine, Rashid Latif Medical College Department of Anesthesia, ICU and Pain Management, Allama Iqbal Medical College, Lahore *Correspondence: Lala Rukh Bangash (lala_bangash@yahoo.com) 10 03 2026 2026 7 1 10 14 30 06 2025 25 01 2026 17 02 2026 Copyright © 2026 The Author(s) 2026 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To assess the knowledge, attitudes, and screening practices of general practitioners (GPs) regarding diabetic neuropathy and identify barriers to guideline implementation in primary care settings.

 Methodology

This cross-sectional survey was conducted from June to December 2024 across Pakistan's public and private outpatient services. A total of 100 licensed GPs involved in diabetic patient care participated in the survey. Data were collected using a validated structured questionnaire and analyzed by using SPSS version 25. Responses were reported as frequencies and associations were calculated using a chi-square test with p < 0.05 taken as significant.

 Results

Out of 100 participants, 56 scored in the Poor/Fair category, 36 scored Moderate, and only 8 scored Good in the knowledge domain. Routine screening was reported by 46% of respondents; most relied on history and physical examination rather than standardized tools. A significant association was found between screening practices and any formal training (p = 0.002), but not with age or duration of clinical practice.

 Conclusion

The findings of this study show the gaps in the knowledge and screening practices of GPs. Routine screening reported by less than 50% of the participants, reliance on informal methods, and inconsistent documentation raise concerns, highlighting an urgent need for targeted educational interventions and reinforcement of screening practices.

 Keywords Diabetic neuropathy general practitioners primary care physicians screening practices knowledge diabetes complications Ethics Statement

Ethics committee: Ethics Committee, Jinnah Burn and Reconstructive Surgery Centre, Lahore, Pakistan. Approval number: 4491/ED/JB&RSC, dated May 05, 2023.

 References Zaino B, Goel R, Devaragudi S, Prakash A, Vaghamashi Y, Sethi Y, et al. Diabetic neuropathy: pathogenesis and evolving principles of management. Dis Mon. 2023;69(9):101582. Jadhao P, Swain J, Das S, Mangaraj S, Sravya SL. Prevalence and predictors of diabetic peripheral neuropathy in newly diagnosed type 2 diabetes mellitus patients. Curr Diabetes Rev. 2025;21(3):e120224226871. Hussain A, Ahmad I, Khan MN, Zar A, Shahzad S. Peripheral Neuropathy Among Patients with Type 2 Diabetes Using Michigan Neuropathy Screening Instrument. J Postgrad Med Inst. 2021;35(1):7-11. Smith S, Normahani P, Lane T, Hohenschurz-Schmidt D, Oliver N, Davies AH. Prevention and management strategies for diabetic neuropathy. Life.2022;12(8):1185. Gad H, Kalra S, Pinzon R, Garcia RaN, Yotsombut K, Coetzee A, et al. Earlier diagnosis of peripheral neuropathy in primary care: a call to action. J Peripher Nerv Syst. 2024;29(1):28-37. Samsu N. Diabetic nephropathy: challenges in pathogenesis, diagnosis, and treatment. BioMed Res Int. 2021;2021(1):1497449. Tesfaye S, Brill S, Eerdekens M, Labrador MM, Petersen G, de Rooij Peek A, et al. Diagnosis, management and impact of painful diabetic peripheral neuropathy: A patient survey in four European countries. J Diabetes Complications. 2023;37(4):108417. Committee ADAPP. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2025. Diabetes Care. 2024;48(Suppl 1):S252-S65. Nkonge KM, Nkonge DK, Nkonge TN. Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetol Metab Syndr. 2023;15(1):55. Ziegler D, Landgraf R, Lobmann R, Reiners K, Rett K, Schnell O, et al. Screening and diagnosis of diabetic polyneuropathy in clinical practice: A survey among German physicians (PROTECT Study Survey). Prim Care Diabetes. 2022;16(6):804-9. Tanırlar M, Arslan M, Edirne T, Emre N, Özşahin A. Evaluation of knowledge level and approaches of physicians working in primary health care institutions in Denizli Province on diabetic neuropathy. Ankara Med J. 2022. 22(3): 359-69. Tandon N, Thakkar PB, Jacob J, Kalra P, Arun N, Kanungo A, et al. Healthcare Practitioners' Perspective of Prevailing Awareness on Diabetes Complications: A Questionnaire-Based Pan-India Study. Cureus. 2023;15(7): e42568. Eid SA, Rumora AE, Beirowski B, Bennett DL, Hur J, Savelieff MG, et al. New perspectives in diabetic neuropathy. Neuron. 2023;111(17):2623-41. Pinzon R, Kes M, Lima RSR, Sa R. De. Diabetic peripheral neuropathy: Is it underdiagnosed. Asian J Biol Sci. 2020;13(2):168-72. Longa-López J. Physicians'attitudes towards the approach to diabetic neuropathy in public and private health care facilities, 2023. Revista Facultad Med Humana. 2023;23(4), 54–61. Gassas R. Sources of the knowledge-practice gap in nursing: Lessons from an integrative review. Nurse Educ Today. 2021;106:105095. 10.1016/j.nedt.2021.105095. Anastasi JK, Capili B. Detecting peripheral neuropathy in patients with diabetes, prediabetes and other high-risk conditions: an advanced practice nurse’s perspective. J Med Clin Nurs. 2022;3(2):143. Zhao N, Xu J, Zhou Q, Hu J, Luo W, Li X, et al. Screening behaviors for diabetic foot risk and their influencing factors among general practitioners: a cross-sectional study in Changsha, China. BMC Primary Care. 2023;24(1):68.