DIABETIC NEUROPATHY: COMPREHENSIVE INSIGHTS INTO MECHANISMS, DIAGNOSIS, AND THERAPEUTIC APPROACHES

Amar Sandeep Bhowad*, Sunita Ogale

ABSTRACT

Background: Diabetic neuropathy (DN) is one of the most prevalent complications of diabetes mellitus, affecting up to half of patients over their lifetime. It encompasses a spectrum of peripheral and autonomic nerve disorders resulting from chronic hyperglycemia, and significantly impairs quality of life while contributing to high morbidity (e.g. foot ulcers, amputations) and mortality. Objective: This review provides a comprehensive overview of DN, including global epidemiology, underlying mechanisms, clinical diagnosis, current treatments, ongoing challenges, and future directions. Methods: We synthesized recent (2019–2024) clinical research and review literature on DN, emphasizing human studies and global perspectives. Results: Globally, an estimated 22–47% of diabetes patients have peripheral neuropathy, with higher rates in long-standing and poorly controlled disease. Chronic hyperglycemia induces metabolic and microvascular changes (e.g. oxidative stress, inflammation, ischemia) that damage nerve fibres. Diagnosis relies on clinical evaluation (symptoms, sensory testing) and should be performed at diabetes diagnosis and annually thereafter. There are no curative treatments; tight glycemic control can prevent or slow neuropathy, especially in type 1 diabetes. Symptomatic management of neuropathic pain includes medications like duloxetine, pregabalin, gabapentin, and tricyclic antidepressants, which provide partial relief in about 50% of patients. Conclusions: DN remains a challenging condition with substantial global impact. Key challenges include underdiagnosis in primary care and lack of disease-modifying therapies. Future directions involve early detection (e.g. via biomarkers or corneal imaging) and development of novel treatments targeting pathogenic pathways and nerve regeneration. Multidisciplinary strategies are needed to improve patient outcomes.

Keywords: Diabetic neuropathy; Diabetic peripheral neuropathy; Diabetes complications; Neuropathic pain; Pathophysiology; Diagnosis; Treatment; Future directions.