Diabetic neuropathy is a complex and multifaceted disorder of the peripheral nervous system. Here are highlights from the review of the complication:
1. In addition to traditional risk factors—hyperglycemia and diabetes duration — obesity, dyslipidemia, hypertension, and genetic contributors are equally as important.
2. Schwann cells, peripheral nerve support cells, help axons meet their high energy demands by supplying them with energy substrates, such as lactate, under normal/healthy conditions.
3. Under diabetic conditions, hyperglycemia and dyslipidemia disrupt Schwann cells’ energy support to axons, which triggers nerve bioenergetics failure and injury.
4. The review also covers pain mechanisms, including cellular events separate from the nerve that contribute to painful neuropathy.
5. Lastly, it discusses emerging potential therapy targets outside of tight glucose control, including lifestyle interventions.