Diabetic polyneuropathy affects 30–50% of patients with diabetes mellitus. It encompasses several neuropathic syndromes, the most common being distal symmetrical polyneuropathy or ‘diabetic peripheral neuropathy’ (DPN). Risk factors for DPN include poor glycaemic control and drivers of macrovascular disease including hypertension. Strong evidence in humans and animals implicates nerve ischaemia as the cause of DPN. Despite several well-designed recent trials, no novel approved treatment with unequivocal effects on nerve function decline in DPN has emerged.