Over half of people with
diabetes mellitus develop
diabetic polyneuropathy (
DPN), which is a major cause of reduced quality of life due to disabling
neuropathic pain, sensory loss, gait instability, fall-related injury, and foot ulceration and
amputation. The latter represents a major health and economic burden, with lower limb
amputation rates related to diabetes increasing in the UK. There is a need for early diagnosis of
DPN so that early management strategies may be instigated, such as achieving tight
glucose control and management of cardiovascular risk factors, in an attempt to slow its progression. To this end, a one-stop microvascular assessment involving a combined eye, foot and renal screening clinic has proven feasible in the UK. Unfortunately, there are currently no approved disease-modifying
therapies for
DPN. Some disease-modifying agents have demonstrated efficacy, but further large trials using appropriate clinical endpoints are required before these treatments can be routinely recommended. There has been emerging evidence highlighting a reduction in
vitamin D levels in cases of painful
DPN and the potential for
vitamin D supplementation in deficient individuals to improve
neuropathic pain; however, this needs to be proved in randomised clinical trials. The use of established agents for
neuropathic pain in
DPN is limited by poor efficacy and adverse effects, but patient stratification using methods such as
pain phenotyping are being tested to determine whether this improves the outcomes of such agents in clinical studies. In addition, innovative approaches such as the topical 8%
capsaicin patch, new methods of electrical stimulation and novel therapeutic targets such as NaV1.7 offer promise for the future. This article aims to discuss the challenges of diagnosing and managing
DPN and to review current and emerging lifestyle interventions and therapeutic options.