Diabetic neuropathy: Why targeted treatment is pivotal for nerve pain?

Diabetes cases in India continue to rise like never before, leading to a variety of complications that usually remain under-recognised until they start impacting daily activities. Diabetic peripheral neuropathy is among the most debilitating of such complications, a type of nerve damage caused by persistently high blood sugar levels associated with diabetes.

Can an A1c of 5.7 cause neuropathy?

High blood sugar gradually affects the peripheral nerve fibres, and since there are more than 101 million Indians diagnosed with diabetes, almost 25% of the population may experience neuropathy. A large 2026 study involving over 153,000 adults across India further highlighted the scale of the issue, reporting the prevalence of peripheral neuropathy to be as high as 90.1% among people living with diabetes.

Diabetic neuropathy is a type of nerve damage most commonly affecting the nerves in the hands and feet, leading to symptoms such as burning pain, tingling, numbness and heightened sensitivity to touch. Clinical data shows that 50% to 88% of patients with chronic pain also suffer from poor sleep, creating a vicious cycle where sleep disruption worsens pain awareness and lowers pain tolerance, resulting in emotional distress and a decline in quality of life. High blood sugar levels, a long history of diabetes, obesity, age over 40 and complications like hypertension or high cholesterol can be among the risk factors of developing diabetic neuropathy.

Can nerve damage from diabetes be repaired?

Importantly, neuropathic pain is fundamentally different from general pain. Unlike pain caused by injury or inflammation, diabetic nerve pain arises from damaged nerves sending abnormal signals to the brain. However, it is normally managed in the same manner as general pain. Usually, it is treated using systemic oral medication such as anticonvulsants and antidepressants. While these treatments might work well for some patients, others have been known to feel that they do not get adequate relief from their symptoms.

What is the new treatment for diabetic neuropathy?

Hence, there is growing awareness that treatments for diabetic nerve pain need to be more targeted and mechanism-based. This has resulted in an increasing amount of research being conducted into local topical application solutions that work at the source of pain, as opposed to applying medication all over the body.

Among these, a topical solution with 0.075% capsaicin has emerged as an evidence-based option for localised neuropathic pain conditions, including painful diabetic peripheral neuropathy. Capsaicin acts on TRPV1 pain receptors in the skin and, with repeated application, helps desensitise hyperactive pain fibres and reduce abnormal nerve firing over time. A comprehensive systematic review involving over 1,800 patients across 22 clinical studies reinforced the role of 0.075% capsaicin as an effective ingredient and generally well-tolerated treatment option with greater efficacy. The review reported meaningful reductions in pain intensity along with improvements in daily functioning and quality-of-life outcomes. There were significant reductions in pain intensity, as well as improvements in daily activities and quality of life outcomes.

Can nerve damage be repaired in diabetes?

As diabetes prevalence continues to rise in India, improving awareness around diabetic neuropathy and ensuring earlier, more targeted intervention will become increasingly important. Recognising that neuropathic pain is not “just pain.” Still, a nerve-driven condition requiring precision-led care may help improve outcomes and quality of life for millions of patients living with diabetes.