Background: Diabetic peripheral neuropathy (DPN) is characterized by complex neuropathy-related pain, discomfort with daily activities, sleep disturbance, and decreased QOL rather than pain per se. Thus, a comprehensive approach regarding the impact of DPN on these health-related issues is needed. 
Aim: To identify subgroups of DPN patients according to a composite of sensory symptoms and the clinical impacts on pain severity, sleep disturbance, and QOL
Method: A hierarchical cluster analysis was performed to identify relevant subgroups of patients with DPN (n = 1,338) from the Korean Diabetes Association Neuropathy Study (2010). The scores on the Michigan Neuropathy Screening Instrument (MNSI) questionnaire, Brief Pain Inventory-Short Form, visual analogue scale, Medical Outcomes Study Sleep Scale, and EuroQol were used as variables.
Results: Patients with DPN were divided into three clusters: asymptomatic (Cluster 1, n = 448, 33.5%), moderate symptoms with disturbed sleep (Cluster 2, n = 562, 42.0%) and severe symptoms with decreased quality of life (Cluster 3, n = 328, 24.5%). Patients in Cluster 3, compared with Clusters 1 and 2, were characterised by higher levels of HbA1c, more prevalent retinopathy and nephropathy, and more severe pain and mental and physical impairments. Patients in Cluster 2 had moderate pain levels but disturbed sleep patterns comparable to those of the patients in Cluster 3. The symptoms on the MNSI showed a similar distribution pattern but different severities among the three clusters.
Discussion: Cluster analysis endorsed the use of symptomatic and comprehensive subgrouping to individualise the evaluation and treatment of patients with DPN.

Cluster analysis of neuropathic symptoms in subjects with diabetic peripheral neuropathy