Diabetic Neuropathies

Continuum (Minneap Minn). 2023 Oct 1;29(5):1401-1417. doi: 10.1212/CON.0000000000001291.


Objective: This article provides an up-to-date review of the diagnosis and management of the most common neuropathies that occur in patients with diabetes.

Latest developments: The prevalence of diabetes continues to grow worldwide and, as a result, the burden of diabetic neuropathies is also increasing. Most diabetic neuropathies are caused by hyperglycemic effects on small and large fiber nerves, and glycemic control in individuals with type 1 diabetes reduces neuropathy prevalence. However, among people with type 2 diabetes, additional factors, particularly metabolic syndrome components, play a role and should be addressed. Although length-dependent distal symmetric polyneuropathy is the most common form of neuropathy, autonomic syndromes, particularly cardiovascular autonomic neuropathy, are associated with increased mortality, whereas lumbosacral radiculoplexus neuropathy and treatment-induced neuropathy cause substantial morbidity. Recent evidence-based guidelines have updated the recommended treatment options to manage pain associated with distal symmetric polyneuropathy of diabetes.

Essential points: Identifying and appropriately diagnosing the neuropathies of diabetes is key to preventing progression. Until better disease-modifying therapies are identified, management remains focused on diabetes and metabolic risk factor control and pain management.

MeSH terms

  • Diabetes Mellitus, Type 2* / complications
  • Diabetic Neuropathies* / diagnosis
  • Diabetic Neuropathies* / therapy
  • Humans
  • Pain
  • Polyneuropathies*
  • Risk Factors