Diabetic peripheral neuropathy (DPN) is length-dependent peripheral nerve damage arising as a complication of type 1 or type 2 diabetes in up to 50% of patients. DPN poses a substantial burden on patients, who can experience impaired gait and loss of balance, predisposing them to falls and fractures, and neuropathic pain, which is frequently difficult to treat and reduces quality of life. Advanced DPN can lead to diabetic foot ulcers and non-healing wounds that often necessitate lower-limb amputation. From a socioeconomic perspective, DPN increases both direct health-care costs and indirect costs from loss of productivity owing to neuropathy-related disability. In this Review, we highlight the importance of understanding country-specific and region-specific variations in DPN prevalence to inform public health policy and allocate resources appropriately. We also explore how identification of DPN risk factors can guide treatment and prevention strategies and aid the development of health-care infrastructure for populations at risk. We review evidence that metabolic factors beyond hyperglycaemia contribute to DPN development, necessitating a shift from pure glycaemic control to multi-targeted metabolic control, including weight loss and improvements in lipid profiles.

糖尿病周围神经病变 （DPN） 是长度依赖性的周围神经损伤，是 1 型或 2 型糖尿病的并发症，在高达 50% 的患者中出现。DPN 给患者带来了沉重的负担，他们可能会出现步态受损和失去平衡，使他们容易跌倒和骨折，以及神经性疼痛，这通常很难治疗并降低生活质量。晚期 DPN 可导致糖尿病足溃疡和不愈合的伤口，通常需要下肢截肢。从社会经济角度来看，DPN 增加了直接医疗保健成本和因神经病变相关残疾而导致的生产力损失的间接成本。在本综述中，我们强调了了解 DPN 患病率的特定国家和区域差异的重要性，以便为公共卫生政策提供信息并适当分配资源。我们还探讨了 DPN 风险因素的识别如何指导治疗和预防策略，并帮助为高危人群发展医疗保健基础设施。我们回顾了高血糖以外的代谢因素有助于 DPN 发展的证据，因此需要从纯粹的血糖控制转变为多目标代谢控制，包括体重减轻和血脂水平的改善。