Diabetic neuropathy is a prevalent and disabling condition, primarily affecting peripheral nerves. The most common form is distal symmetric polyneuropathy (DSP), characterized by symptoms such as numbness, tingling, pain, and weakness, typically starting in the feet and spreading proximally. DSP significantly impacts patients' quality of life, increasing the risk of falls, ulcerations, and lower extremity amputations. Glucose control and pain management are the primary treatments, with glucose control being the only proven disease-modifying intervention. However, its effectiveness is more pronounced in type 1 diabetes than in type 2. Pain management, particularly with anticonvulsants and antidepressants, is crucial for improving patients' quality of life. While tight glucose control reduces neuropathy in type 1 diabetes, its impact is less significant in type 2. Metabolic syndrome components, including pre-diabetes, may also be risk factors for neuropathy, warranting further research. Understanding the underlying mechanisms and identifying new modifiable risk factors is essential for developing better treatments and preventing neuropathy progression.Diabetic neuropathy is a prevalent and disabling condition, primarily affecting peripheral nerves. The most common form is distal symmetric polyneuropathy (DSP), characterized by symptoms such as numbness, tingling, pain, and weakness, typically starting in the feet and spreading proximally. DSP significantly impacts patients' quality of life, increasing the risk of falls, ulcerations, and lower extremity amputations. Glucose control and pain management are the primary treatments, with glucose control being the only proven disease-modifying intervention. However, its effectiveness is more pronounced in type 1 diabetes than in type 2. Pain management, particularly with anticonvulsants and antidepressants, is crucial for improving patients' quality of life. While tight glucose control reduces neuropathy in type 1 diabetes, its impact is less significant in type 2. Metabolic syndrome components, including pre-diabetes, may also be risk factors for neuropathy, warranting further research. Understanding the underlying mechanisms and identifying new modifiable risk factors is essential for developing better treatments and preventing neuropathy progression.