Early Detection and Risk Stratification of Diabetic Peripheral Neuropathy in Adults with Type 2 Diabetes: An Evidence-Informed Narrative Review with Implications for Nursing Practice

Abstract

Diabetic peripheral neuropathy (DPN) is a frequent and potentially underrecognized complication of type 2 diabetes mellitus (T2DM). Early detection matters because sensory dysfunction may precede recognizable symptoms, whereas loss of protective sensation increases the risk of foot injury and ulceration. This evidence-informed narrative review integrates current clinical guidance with representative observational, diagnostic, longitudinal, and evidence-synthesis studies to examine risk stratification and practical screening strategies for adults with T2DM, with particular attention to nursing practice. Evidence supports assessment at T2DM diagnosis and at least annually thereafter, combining symptom history with small-fiber and large-fiber sensory tests and evaluation of protective sensation. Although the 10-g monofilament is useful for identifying feet at ulcer risk, it should not be treated as a stand-alone rule-out test for early neuropathy. Findings on individual test accuracy vary with reference standards, thresholds, and populations. Established risk indicators include diabetes duration, glycemic exposure, and coexisting vascular or microvascular disease; prediction algorithms and corneal confocal microscopy show promise but require careful external validation and consideration of resources. A feasible nursing pathway is proposed that links structured history-taking, multimodal bedside examination, foot-risk classification, education, documentation, and timely referral. The most important research priorities are prospective validation of integrated screening pathways, implementation in primary care, and measurement of patient-important outcomes rather than diagnostic accuracy alone.