Diabetic Peripheral Neuropathy: Current Epidemiology, Diagnostic Advances, Biomarkers, and Management Strategies

Diabetic peripheral neuropathy (DPN) is one of the most common and disabling complications of diabetes mellitus (DM), affecting up to 50% of patients during the course of their disease. The condition manifests predominantly as a distal symmetric polyneuropathy, with early involvement of small fibers and progressive sensory loss. Epidemiological data show high prevalence not only in type 1 and type 2 diabetes but also in prediabetic populations, highlighting the need for early detection. The pathophysiology of DPN is complex, involving metabolic dysregulation, oxidative stress, vascular insufficiency, inflammation, and mitochondrial dysfunction. Diagnostic tools range from clinical examination and nerve conduction studies (NCS) to magnetic resonance imaging. Recent advances in plasma and neuroimaging biomarkers offer promising avenues for earlier and more accurate diagnosis. Management focuses on strict glycemic control, risk factor modification, symptomatic treatment of neuropathic pain, and lifestyle interventions. Despite ongoing research, no curative therapy currently exists, underscoring the urgent need for disease-modifying strategies. A multidisciplinary, patient-centered approach is essential to mitigate complications and improve quality of life. This review provides a comprehensive overview of DPN, covering its epidemiology, pathogenesis, diagnostic approaches, emerging biomarkers, and current management strategies. Future research should emphasize biomarker validation, longitudinal monitoring, and personalized therapeutic interventions.