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

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.