Diabetic Neuropathies

Aaron Izenberg, MD, FRCPC; Bruce A. Perkins, MD, MPH, FRCPC; Vera Bril, MD, FRCPC


Semin Neurol. 2015;35(4):424-430. 

In This Article

Abstract and Introduction


Diabetes mellitus is a common condition and diabetics are prone to develop a spectrum of neuropathic complications ranging from symmetric and diffuse to asymmetric and focal neuropathies that may be associated with significant morbidity. Diabetic sensorimotor polyneuropathy is the most common of these complications, occurring in patients with type 1 and 2 diabetes mellitus, as well as in those with prediabetes and glucose intolerance. In this review, the authors discuss the wide variety of neuropathies that can present in the context of diabetes, including the clinical manifestations, diagnostic features, and approach to management.


Diabetes mellitus is a global epidemic in developing and developed countries. Presently in the United States over 9% of the population is affected, and the prevalence is nearly 26% for individuals over age 65;[1] by 2050, it is estimated that one in three people will have the condition. In addition, prediabetes affects 37% of Americans over the age of 20; there are an estimated 8.1 million people with undiagnosed diabetes mellitus.[1] On a global scale, it is estimated that the number of people affected by diabetes mellitus will double to 366 million by 2030.[2]

Diabetes mellitus frequently affects the peripheral nervous system and is the most common cause of neuropathy in the world today. Peripheral neuropathy will occur in up to 50% of all patients with diabetes mellitus[3,4] Moreover, a substantial subset of asymptomatic patients may have electrophysiological features of neuropathy.[5]

Though diabetic sensorimotor polyneuropathy (DSP) is the most common manifestation,[6] there are several other neuropathy syndromes that can occur in the context of diabetes mellitus. These include small fiber and autonomic neuropathies, as well as asymmetric and focal processes including mononeuropathies, cranial neuropathies, and radiculoplexus neuropathies (see Table 1). In this review, we will summarize the clinical features, diagnostic approach, and treatment options for the more commonly encountered syndromes.