Patients with high distress had increased odds of diabetic neuropathy (OR: 1.67, 95% confidence interval [CI]: 1.25–2.23), which remained significant after adjusting for multiple variables, including age, sex, BMI, duration of diabetes, systolic blood pressure, HbA1c, eGFR, use of insulin, use of statin, and alcohol intake and smoking (adjusted OR: 1.66, 95% CI: 1.22–2.26). Here, INS is linked to diabetic neuropathy.