The Complex Landscape of Diabetic Neuropathy: A Review of Mechanisms and Management Approaches

Abstract

Diabetic neuropathy (DN) represents one of the most prevalent and debilitating complications of diabetes mellitus, affecting approximately 30-50% of patients with long-standing disease. It encompasses a heterogeneous group of disorders, with distal symmetric polyneuropathy (DSPN) being the most common clinical presentation. The pathogenesis of DN is multifactorial, involving chronic hyperglycemia-induced metabolic derangements, oxidative stress, microvascular dysfunction, and neuroinflammation. Despite significant advances in understanding its underlying mechanisms, effective disease-modifying therapies remain elusive, and current clinical management primarily focuses on glycemic control and symptomatic relief. This review provides a comprehensive examination of the molecular and cellular mechanisms contributing to DN, critically discusses emerging therapeutic targets, and evaluates evidence-based management strategies. Additionally, we highlight key gaps in current knowledge and propose future directions for both research and clinical practice to improve patient outcomes.