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Background Painful diabetic neuropathy is one of the most common complications of type 2 diabetes mellitus, with approximately 30–50% of people will experience diabetic neuropathy. Chronic hyperglycemia will cause an inflammatory process that will trigger an immune response included leukotrienes. Leukotriene B4 is associated with hemoglobin glycation levels. This study aimed to determine high serum leukotriene B4 levels and other factors as a risk factor for painful diabetic neuropathy in type 2 diabetes mellitus patient. Results Forty-two subjects with 22 cases (median age 56.5 ± 4.9 years) and 20 controls (median age 56.5 ± 5.2 years) group were collected. In bivariate analysis, significant factor for high risk PDN was high leukotriene B4 serum level (OR 5.10; 95% CI 1.34–19.4,  p  0.014). Meanwhile, insignificant factors were anti-diabetic drugs (OR 2.139; 0.62–7.37;  p  = 0.226), and duration of diabetes mellitus (OR 2.282; 0.56–9.25;  p  = 0.315). Independent risk factor was serum leukotriene B4 levels (OR 5.10; 95% CI 1.336–19.470;  p  = 0.017). Conclusions In this study, high leukotriene B4 serum levels increase the risk of painful diabetic neuropathy among type 2 diabetes mellitus. The leukotriene B4 may consider as a potential biomarker for early detection in high risk for PDN and early treatment.

High leukotriene B4 serum levels increase risk of painful diabetic neuropathy among type 2 diabetes mellitus patients