Diabetic Neuropathies

This article provides an update on the biological mechanisms and risk factors for the varied manifestations of diabetes-associated nerve injury, and reviews current diagnostic and treatment approaches.

Diabetic peripheral neuropathy was recently identified as one of the top five leading global neurologic causes of disease burden. Multiple metabolic derangements beyond hyperglycemia, such as the metabolic syndrome, drive diabetic peripheral neuropathy pathogenesis. Social determinants of health are also increasingly seen as important contributors. The biological effects of diabetes are detrimental to both peripheral nerve axons and Schwann cells, and disruptions to the intricate Schwann cell-axon relationship in the diabetic environment are becoming better understood. With improved technology and larger data sets, genetic and epigenetic contributors to diabetic peripheral neuropathy and neuropathic pain are also emerging.

Diabetes-associated nerve injury is highly prevalent and results in a marked reduction in quality of life and increased mortality. Despite this disease burden, screening for its many manifestations remains insufficient. Disease-modifying treatments are also limited, necessitating the early implementation of preventative measures. To reduce nerve injury burden in people with diabetes, clinicians must work in multidisciplinary teams and tailor treatments to the patient's symptoms and risk factors.