Diabetic neuropathy refers to a group of conditions that damage the nervous system in individuals with diabetes mellitus; they affect various organ systems such as the musculoskeletal, cardiovascular, gastrointestinal, and urogenital systems. The most common form is distal symmetric polyneuropathy, which primarily affects the lower limbs and feet and ultimately reduces quality of life.

Diabetic neuropathy occurs with nonspecific symptoms such as numbness, tingling, pain in the legs and feet, gastrointestinal issues, and erectile dysfunction, which can lead to misdiagnosis. Diagnostic tests may reveal poor nerve function, impaired sensations, orthostatic hypotension, resting tachycardia, and delayed gastric emptying.

Diabetic neuropathy is diagnosed through annual assessments for people with type 1 diabetes (after 5 years) and all individuals with type 2 diabetes; these assessments involve clinical tests for sensations like vibration, thermal changes, and pain. The diagnosis is a process of exclusion, in which alternative causes for the symptoms are ruled out before confirming diabetic neuropathy.

The main medical treatments for diabetic neuropathy focus on improving blood glucose control through lifestyle changes and glucose-lowering medications because there are no specific treatments for nerve damage. Additionally, pain-reducing medications like pregabalin or duloxetine are used to alleviate pain and enhance quality of life, which can also encourage increased physical activity.

Research has investigated several supplements for diabetic neuropathy, including vitamin D, vitamin B12, L-carnitine, and alpha-lipoic acid. However, more high-quality randomized controlled trials are necessary to determine their effectiveness in reducing the risk or alleviating symptoms of diabetic neuropathy.

Diet can affect diabetic neuropathy by improving blood glucose control through making individualized dietary changes that are aimed at weight loss and minimizing postmeal blood sugar spikes. Additionally, deficiencies in specific micronutrients like vitamin D and vitamin B12 may increase the risk of diabetic neuropathy, particularly in people with limited dietary sources of these vitamins.

Aerobic exercise and sensorimotor training can help alleviate symptoms of diabetic peripheral neuropathy, and low-frequency electrical stimulation of the spinal cord may reduce the associated pain. However, further high-quality randomized controlled trials are necessary to assess the efficacy and safety of neuromodulation therapy.

The exact causes of diabetic neuropathy are not fully understood, but it is believed that persistently high blood glucose and lipids contribute to neuronal oxidative stress and chronic low-grade inflammation, which result in nerve damage.