Diabetic Neuropathy in Older Adults: Pathophysiological and Clinical Approach

Introduction: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disorder among older adults. Its prolonged and poorly controlled course promotes the development of microvascular and neurological complications, including peripheral diabetic neuropathy (PDN), which affects more than 50% of this population. It is characterized by neuropathic pain, sensory loss, and motor dysfunction. Objective: To analyze the pathophysiological mechanisms involved in the development and progression of PDN in older adults with T2DM, as well as the main diagnostic approaches used for early detection. Methodology: A narrative review of the scientific literature published between 2020 and 2025 was conducted through a critical analysis of 28 articles selected based on thematic relevance and methodological rigor. The search was performed in recognized databases (Google Scholar, Dialnet, Scielo, and PubMed), using descriptors in Spanish, English, and Portuguese related to PDN, T2DM, and aging. Results: PDN in geriatric patients with T2DM is associated with multiple pathophysiological mechanisms, including neurotoxicity, oxidative stress, arteriosclerosis, peripheral nerve demyelination, and microvascular dysfunction. Key metabolic pathways are described (protein kinase C, hexosamine, and polyol pathways), along with the involvement of reactive oxygen species, dyslipidemia, and chronic inflammation. Diagnosis is supported by tools such as the Michigan Neuropathy Screening Instrument (MNSI) and the 10 g monofilament test, which show high sensitivity (79%) and specificity (94%). However, in Ecuador in 2022, only 33.3% of cases were confirmed using the monofilament test, highlighting gaps in timely diagnosis. PDN increases the risk of diabetic foot and amputations by 55%. Conclusion: PDN represents one of the most common and disabling complications in older adults with T2DM, driven by multiple factors and pathophysiological processes. Understanding its underlying mechanisms and employing effective diagnostic tools are essential for early detection, comprehensive management, and prevention of severe complications such as diabetic foot.