Painful and Non-painful Diabetic Neuropathy, Diagnostic Challenges and Implications for Future Management

Troels S. Jensen; Pall Karlsson; Sandra S. Gylfadottir; Signe T. Andersen; David L. Bennett; Hatice Tankisi; Nanna B. Finnerup; Astrid J. Terkelsen; Karolina Khan; Andreas C. Themistocleous; Alexander G. Kristensen; Mustapha Itani; Søren H. Sindrup; Henning Andersen; Morten Charles; Eva L. Feldman; Brian C. Callaghan


Brain. 2021;144(6):1632-1645. 

In This Article

Conclusion and Suggestions for the Future

The diagnosis of DN and painful DN has changed over the last few decades, shifting from a descriptive delineation to a more detailed distinction, based on specific pathophysiological mechanisms. However, despite the introduction of new diagnostic tests, novel potential biomarkers, and a series of rather small intervention studies utilizing detailed phenotypic profiling, the management of DN and painful DN has remained largely unchanged. For DN, glycaemic control remains the sole intervention. For painful DN, no specific disease-modifying intervention exists and symptomatic management is still the treatment mainstay. To advance the current state of the field, large, prospective, cohort studies are needed to determine the value of the different diagnostic tests, e.g. NCS, IENFD, for diagnosing DN and painful DN and tracking progression. Furthermore, pharmacological intervention studies in a research setting using the principles of precision medicine may facilitate discovery of new disease-modifying therapies for DN and painful DN for ultimate clinical application. Given the high prevalence and morbidity associated with DN and painful DN, advances in the diagnosis and treatment of these patients will have a great impact on the health of a large number of patients worldwide.