Serum Uric Acid and Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus: A Cross‐Sectional Study From Northeastern Tanzania

Abstract

Background Diabetic peripheral neuropathy (DPN) is a common and disabling complication of Type 2 diabetes mellitus (T2DM). Emerging evidence suggests that elevated serum uric acid (SUA) may associate with microvascular complications; however, data from sub‐Saharan Africa remain limited. We examined the association between hyperuricemia and DPN among adults with T2DM in northern Tanzania. Methods We conducted a hospital‐based cross‐sectional analytical study at a tertiary diabetes clinic from November 2024 to April 2025. Adults aged ≥ 18 years with established T2DM were consecutively recruited. DPN was assessed using the Toronto Clinical Scoring System (TCSS), with DPN defined as TCSS ≥ 6. Fasting SUA was classified as elevated at ≥ 340 μmol/L in women and ≥ 420 μmol/L in men. Multivariable logistic regression estimated adjusted odds ratios (aORs). Receiver operating characteristic (ROC) analysis assessed discriminatory performance. Results Of 321 clinic attendees, 220 participants met eligibility criteria and were analyzed (mean age < 65 years: 69.1%; male: 53.2%). DPN prevalence was 51.8% (114/220). Elevated SUA was present in 52.7% and was strongly associated with DPN (aOR 5.89, 95% CI 3.01–11.51, p < 0.001). Diabetes duration ≥ 5 years (aOR 3.81, p = 0.016), overweight status (aOR 2.18, p = 0.034), elevated fasting glucose (aOR 2.20, p = 0.022), and low HDL (aOR 2.10, p = 0.040) were independently associated with DPN. Elevated total cholesterol was inversely associated (aOR 0.36, p = 0.003). SUA demonstrated moderate discrimination for DPN (AUC 0.773). Conclusions Hyperuricemia was independently associated with prevalent DPN in this Tanzanian study. SUA may represent a clinically accessible marker for neuropathy risk stratification in resource‐limited settings.