What clinical features should I assess to differentiate between diabetic and non-diabetic peripheral neuropathy?

To differentiate between diabetic and non-diabetic peripheral neuropathy, assess the clinical features focusing on the pattern, associated systemic signs, and risk factors. Diabetic peripheral neuropathy typically presents as a symmetrical, distal, 'glove and stocking' sensory loss with reduced sensation to light touch, vibration (using a 10 g monofilament), and proprioception, often accompanied by neuropathic pain and autonomic symptoms such as sweating abnormalities and postural hypotension. It commonly coexists with other diabetic complications like peripheral arterial disease and foot deformities, and is associated with a history of diabetes and poor glycaemic control NICE CKS,NICE CKS,NICE NG19. Non-diabetic peripheral neuropathy may present with asymmetrical or proximal involvement, rapid progression, or additional neurological signs such as brisk reflexes or central nervous system features, which are less typical in diabetic neuropathy NICE NG127. Consider other causes by assessing for vitamin B12 deficiency, thyroid dysfunction, alcohol misuse, inflammatory markers, and coeliac disease, as these are common non-diabetic etiologies NICE NG127. Autonomic symptoms in diabetic neuropathy often have a gradual onset and include gastrointestinal symptoms (gastroparesis), urinary retention, and sexual dysfunction, which may help distinguish diabetic neuropathy from other causes NICE CKS,NICE CKS. The presence of acute painful neuropathy following rapid glucose control improvement is characteristic of diabetes NICE CKS,NICE CKS. In contrast, non-diabetic neuropathies may have different temporal profiles and associated systemic illnesses. Therefore, a thorough history including diabetes status, symptom distribution, progression, autonomic involvement, and targeted investigations for alternative causes is essential for differentiation NICE CKS,NICE CKS,NICE NG127 Imreová & Pura 2005.