UC San Diego

Key PointsPeripheral neuropathy is a serious but often neglected complication of diabetes mellitusSchwann cells support the structural and functional integrity of nerves, so their damage as a result of the metabolic consequences of diabetes adversely affects axonsHigh polyol pathway flux, oxidative stress and inflammation are the main pathways activated in Schwann cells during diabetic neuropathyDisruption of Schwann cell metabolism by hyperglycaemia and/or dyslipidaemia results in accumulation of neurotoxic intermediates that confer axonal and vascular vulnerability to injuryMicrovascular changes within the endoneurium create a hypoxic environment that has the potential to disrupt Schwann cell function, promoting activation of inflammatory cascades that lead to neurodegeneration