Artificial intelligence for detection, prediction, and severity classification of diabetic peripheral neuropathy: a...

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes and an important contributor to foot ulceration and lower limb amputation. Early detection remains challenging because conventional screening methods are often subjective, resource-intensive, and insensitive to subclinical disease. Artificial intelligence (AI) has increasingly been applied to support DPN assessment, but its applications across different clinical tasks have not been clearly synthesised. This systematic review evaluates AI applications for DPN detection, prognostic prediction, risk stratification, and severity classification.

A systematic literature search was conducted across PubMed, Scopus, and IEEE Xplore for studies published from January 2021 to 1 September 2025. Studies developing or validating AI models for DPN assessment using patient datasets were included. Study selection was performed by one reviewer, with a second reviewer contributing to uncertain inclusion decisions. Data extraction and risk-of-bias assessment were performed by one reviewer and verified by another using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Due to heterogeneity in clinical tasks, data types, outcome definitions, and validation approaches, findings were synthesised narratively.

Twenty-six studies were included and stratified by clinical task: diagnostic detection of existing DPN, prognostic prediction or risk stratification, and severity classification. Diagnostic detection studies mainly used corneal confocal microscopy, plantar pressure or gait-based assessments, nerve conduction studies, electromyography, and selected clinical variables. Prognostic prediction and risk stratification studies relied mainly on electronic medical record variables, including age, diabetes duration, glycated haemoglobin, renal markers, inflammatory markers, and cardiovascular risk factors. Severity classification studies used electrophysiological measures, structured clinical examination findings, and symptom-based scores. Across tasks, age, diabetes duration, and glycaemic control were recurrent predictors, while imaging, gait, plantar pressure, and electrophysiological features were more task-specific. Reported internal performance was often high, but most studies used small or single-centre datasets, heterogeneous reference standards, and limited reporting of predictor importance. External validation was uncommon, and risk of bias was frequently high, particularly in the analysis domain.

AI approaches for DPN assessment show promise, but interpretation depends on task. Future studies should develop task-specific models, report predictor importance transparently, and undertake external and prospective validation before routine clinical implementation.