New Horizons in Diabetic Neuropathy: Highlights from the 2025 ADA and EASD Conferences

Abstract

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.