Diabetes is the Predominant Cause of Peripheral Neuropathy
Diabetes accounts for approximately 50% of all peripheral neuropathy cases, while gout is not recognized as a direct cause of peripheral neuropathy in clinical practice. 1, 2
Diabetes as the Leading Etiology
The evidence overwhelmingly establishes diabetes as the most common identifiable cause of peripheral neuropathy:
Up to 50% of all adults with diabetes will develop diabetic peripheral neuropathy (DPN) during their lifetime, making it one of the most prevalent complications of diabetes mellitus 1, 2, 3
Among patients with type 2 diabetes specifically, up to 50% have neuropathy and at-risk feet, with diabetic peripheral neuropathy playing a central role in the majority of diabetic foot complications 4
The prevalence of peripheral neuropathy among adults with diabetes ranges from 6% to 51%, depending on factors including age, duration of diabetes, glycemic control, and whether the patient has type 1 versus type 2 diabetes 1
In patients with diabetic foot ulcerations, peripheral neuropathy was identified as a component cause in 78% of cases, demonstrating its critical role in diabetic complications 4
Gout Does Not Cause Peripheral Neuropathy
Gout is not mentioned in any major diabetes or neuropathy guidelines as a cause of peripheral neuropathy 4, 5, 6, 7. The pathophysiology of gout involves crystal deposition in joints causing inflammatory arthritis, not nerve damage. While gout can cause severe joint pain and deformity, it does not produce the characteristic sensory loss, motor dysfunction, or autonomic features of peripheral neuropathy.
Clinical Context and Differential Diagnosis
When evaluating peripheral neuropathy, diabetes must be considered first, but diabetic neuropathy remains a diagnosis of exclusion 4, 5, 7:
Alternative causes must be ruled out, including vitamin B12 deficiency (especially in metformin users), hypothyroidism, renal disease, and medication-induced neuropathy 5, 7
Up to 50% of diabetic peripheral neuropathy may be asymptomatic, yet these patients remain at high risk for foot ulceration and amputation if preventive care is not implemented 4
Among those with symptomatic DPN, 20-40% experience neuropathic pain, which significantly impacts quality of life, sleep, and daily functioning 2, 3, 8
Common Pitfall to Avoid
Do not attribute all neuropathy in diabetic patients solely to diabetes without excluding other treatable causes, as multiple etiologies can coexist and compound neuropathy risk 5, 7.