Red blood cell distribution width/Albumin ratio as an independent predictor of diabetic peripheral neuropathy: A retrospective study

Abstract

Background & Objective: Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes characterized by the involvement of the peripheral nervous system. This study aimed to investigate the association between the red blood cell distribution width/albumin ratio (RAR) and the presence of diabetic peripheral neuropathy (DPN). Methods: The association between DPN, RAR, and other variables was examined using logistic regression analysis. To determine the predictive validity and optimal cutoff value of RAR for the presence of DPN, Receiver Operating Characteristic (ROC) curve analysis was performed to calculate the Area Under the Curve (AUC). Results: Compared to those without DPN, patients with DPN had a significantly higher prevalence of hypertension (p=0.006), a higher rate of smoking (p=0.002), and a longer duration of diabetes (p<0.001). Patients with DPN had significantly lower albumin levels (p<0.001), and significantly higher RDW (p<0.001) and RAR (p<0.001) values. As an independent variable, RAR was independently associated with higher odds of DPN (OR: 1.545, 95% CI: 1.235–1.914, p<0.001). The optimal cutoff value for RAR to predict the presence of DPN was determined to be 4.4 %/(g/dL) (Spec.: 99.2%, Sen.: 32.2%, AUC: 0.67). Conclusion: Our findings suggest that RAR is an independent predictor of DPN and may serve as a complementary biomarker compared with RDW or albumin levels alone. Further prospective, multi-center studies with larger sample sizes are needed to more robustly establish the association between RAR and DPN. © 2026, ASEAN Neurological Association. All rights reserved.