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Clinicians should consider and investigate: Vitamin B12 deficiency (particularly in metformin userscheck serum B12) Hypothyroidism (check thyroid function) Chronic kidney disease (check renal function and eGFR) Alcohol excess Medication-related neuropathy Urgent referral criteria per NICE NG19: Same-day referral to the multidisciplinary foot care service for new ulceration, signs of infection, or suspected active Charcot arthropathy Emergency hospital admission for suspected sepsis, acute limb-threatening ischaemia, or deep-seated soft tissue or bone infection Treatment and Management Options in the UK Management of diabetic neuropathy encompasses both disease-modifying strategies targeting the underlying metabolic dysfunction and symptomatic treatments addressing neuropathic pain and functional impairment