Early predictors and prevention strategies for diabetic neuropathy, a narrative review

Diabetic neuropathy (DN), encompassing distal symmetric polyneuropathy, small‑fiber and autonomic neuropathies, is highly prevalent across the spectrum of dysglycemia and causes neuropathic pain, sensory loss, autonomic dysfunction, foot ulceration, and increased morbidity and mortality. Early detection of subclinical nerve injury and identification of modifiable risk factors permit timely prevention and may reduce long‑term complications. The aim of this study is to synthesize evidence from recent studies on early clinical, metabolic, and paraclinical predictors of diabetic neuropathy and to summarize practical, implementable prevention and screening strategies. The study was conducted as a structured narrative review modeled after the framework of an original research article. The analysis was based on a review of the literature indexed in PubMed concerning early predictors, paraclinical markers, point‑of‑care diagnostics for subclinical neuropathy, primary prevention and multifactorial risk‑reduction strategies recommended in the literature. Small‑fiber autonomic dysfunction, which frequently precede clinically overt large‑fiber loss, is detectable by corneal confocal microscopy, intraepidermal nerve‑fiber density, quantitative sensory testing, and autonomic measures (HRV, cardiovascular autonomic reflex tests), as well as validated devices, enabling earlier risk stratification. Prevention strategies supported or recommended across sources include early risk stratification with combined small‑ and large‑fiber testing, intensive glycemic control,structured lifestyle interventions and comprehensive cardiometabolic management. Multifactorial programs and targeted early interventions are promising but require sensitive endpoints and longer follow‑up to confirm impact on hard outcomes. Prevention of diabetic neuropathy relies on early recognition of clinical and subclinical predictors, incorporation of sensitive screening tools and prompt multifactorial risk modification. Implementation of combined screening and structured education models may improve early detection and reduce downstream morbidity, but prospective trials using sensitive diagnostic endpoints are needed to demonstrate disease modification.