This review highlights key advances in diabetic neuropathy (DN) presented at the 2025 annual meetings of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). New studies confirmed the systemic impact of both diabetic peripheral neuropathy (DPN) and diabetic autonomic neuropathy (DAN). Cardiovascular autonomic neuropathy (CAN) was strongly linked with poor glycaemic control, impaired exercise tolerance, and increased risk of heart failure, particularly in patients with silent myocardial infarction. DSPN independently predicted stroke in type 1 diabetes. DN in general was associated with a higher risk of severe mental illness in type 2 diabetes. Therapeutically, dapagliflozin promoted corneal nerve regeneration through anti-inflammatory pathways. Novel biomarkers, such as plasma methylglyoxal, and advanced neuroimaging emerged as promising tools for risk stratification and personalised pain management. Machine learning applied to neuroimaging data identified neural connectivity patterns predictive of treatment response in painful DN. Basic science studies elucidated new mechanisms, including Schwann cell ferroptosis, and a gut-brain axis contributing to neuropathic pain and cognitive decline. Taken together, these findings promote our understanding of DN pathophysiology and therapy.
American Diabetes Association. Professional practice C. 12. Retinopathy, neuropathy, and foot care: Standards of care in diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S252–S265.
2.
Pop-BusuiRBoultonAJFeldmanEL, et al.Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136–154.
3.
AnastasiouGLiberopoulosETentolourisNPapanasN. Diabetic sensorimotor polyneuropathy: an overview on epidemiology, risk factors, classification, diagnosis, and treatment. Int J Low Extrem Wounds. 2024 Mar 27:15347346241240513. Epub ahead of print.
4.
TentolourisAEleftheriadouITentolourisNPapanasN. Highlights from the 82(nd) ADA scientific sessions and the 58(th) EASD meeting on diabetic neuropathy. Int J Low Extrem Wounds. 2025;24(4):913–917.
5.
RebelosEAnastasiouIATentolourisAPapanasNJudeE. What is new on diabetic neuropathy? Insights from the 2023 ADA and EASD conferences. Int J Low Extrem Wounds. 2024 Feb 28:15347346241233938. Epub ahead of print.
6.
JiaYLongDYangYWangQWuQZhangQ. Diabetic peripheral neuropathy and glycemic variability assessed by continuous glucose monitoring: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2024;213:111757.
7.
BraffettBBebuIEl GhormliL, et al.Association of CGM metrics and HbA1c with ECG-derived cardiovascular autonomic neuropathy in type 1 diabetes. Diabetologia. 2025;68(Suppl 1):S55.
8.
McCarthyOMBrødsgaardRTawfikS, et al.Impact of cardiovascular autonomic neuropathy on cardiopulmonary, sympathoadrenal, and metabolic responses to physical exercise in adults with type 1 diabetes. Diabetologia. 2025;68(Suppl 1):S57.
9.
FengRYanDRanXGaoY. Association of different types of diabetic autonomic neuropathy with left ventricular diastolic dysfunction in patients with type 2 diabetes: A cross-sectional study. Diabetologia. 2025;68(Suppl 1):S58.
10.
LuoQFuYWuL,et al.Diabetic cardiac autonomic neuropathy increases the risk of heart failure among type 2 diabetes mellitus patients with silent myocardial infarction. Diabetes. 2025;74(Suppl 1):106-OR.
11.
ChorepsimaSEleftheriadouITentolourisA, et al.Pulse wave velocity and cardiac autonomic function in type 2 diabetes mellitus. BMC Endocr Disord. 2017;17(1):27.
12.
TentolourisAEleftheriadouIGrigoropoulouP, et al.The association between pulse wave velocity and peripheral neuropathy in patients with type 2 diabetes mellitus. J Diabetes Complications. 2017;31(11):1624–1629.
13.
Pop-BusuiRBraffettBHZinmanB, et al.Cardiovascular autonomic neuropathy and cardiovascular outcomes in the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) study. Diabetes Care. 2017;40(1):94–100.
14.
ItkonenSDahlströmEErikssonM,et al.Peripheral diabetic neuropathy is associated with an increased risk of stroke, independently from other diabetic complications, in individuals with type 1 diabetes. Diabetologia. 2025;68(Suppl 1):S98.
15.
YenYHChengWYYenFSLinHJHwuCMHsuCC. Impact of microvascular complications on severe mental illness risk in patients with type 2 diabetes-A nationwide cohort study in Taiwan. Diabetes2025;74(Suppl 1):107-OR.
16.
ZieglerDPapanasNSchnellO, et al.Current concepts in the management of diabetic polyneuropathy. J Diabetes Investig. 2021;12(4):464–475.
17.
Mondal A JatiPDeyBKBanerjeeS, et al.Dapagliflozin induces nerve fibre regeneration via the microRNA-146a-5p inflammasome pathway in subjects with type 2 diabetes. Diabetologia. 2025;68(Suppl 1):S1060.
18.
PapanasNZieglerD. Emerging drugs for diabetic peripheral neuropathy and neuropathic pain. Expert Opin Emerg Drugs. 2016;21(4):393–407.
19.
PanouTPapanasNGouveriESkoufiGConstantinidisTCNenaE. Diabetic foot and work outcomes: a review. Int J Low Extrem Wounds. 2024 Mar 20:15347346241239719. Epub ahead of print.
20.
BönhofGJFlemingTHSipolaG, et al.Plasma methylglyoxal is linked to nerve dysfunction and predicts increased neuropathic pain intensity over six years in diabetic polyneuropathy. Diabetes. 2025;74(Supplement_1):245-OR.
21.
ZhouJCostacouTOrchardTJMillerRG. Risk factors for 30-year incidence of two peripheral neuropathy phenotypes in type 1 diabetes (T1D). Diabetes. 2025;74(Suppl 1):247-OR.
22.
BorbjergMKMokhtarSSutedjaN, et al.Associations of nerve abnormalities and neuropathic pain with corneal nerve measures in prediabetes and type 2 diabetes. Diabetologia. 2025;68(Suppl 1):S1051.
23.
SelvarajahDZhangJRizkyLR, et al.TNeuroimaging biomarkers for neuropathic pain: A machine learning approach to predicting treatment response. Diabetologia. 2025;68(Suppl 1):S99.
24.
TehKWadeASloanGPGoonooMSTesfayeSSelvarajahD. ADA Presidents’ select abstract: Enhanced dopamine and opioid receptor target engagement predicts neuropathic pain treatment response-A resting-state fMRI study in painful diabetic neuropathy. Diabetes. 2025;74(Supplement_1):105-OR.
25.
Pop-BusuiRGopinathanSGranowitzC, et al.Pilavapadin, an oral, non-opioid, AAK1 inhibitor for diabetic peripheral neuropathic pain: Results from a phase 2b, dose-ranging, randomised, placebo-controlled, multicenter study. Diabetologia. 2025;68(Suppl 1):S100.
26.
FeiSGuoLPanQ. Thyroid-stimulating hormone aggravates ferroptosis in Schwann cells via suppression of the Nrf2/GPX4 pathway: Implications for diabetic peripheral neuropathy. Diabetes. 2025;74(Suppl 1):248-OR.
27.
JinliWRenMWangWYanL. The effects and mechanisms of caloric restriction on diabetic peripheral neuropathy. Diabetes. 2025;74(Suppl 1):1877-LB.
28.
YangJYuanH. Gut microbiota and its metabolites promote painful diabetic peripheral neuropathy complicated with cognitive dysfunction in mice. Diabetologia. 2025;68(Suppl 1):S101.
