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Diabetic polyneuropathy ( DPN ) continues to be generally considered as a “microvascular” complication of diabetes mellitus alongside nephropathy and retinopathy. The microvascular hypothesis, however, might be tempered by the concept that diabetes directly targets dorsal root ganglion sensory neurons. This neuron‐specific concept, supported by accumulating evidence, might account for important features of  DPN , such as its early sensory neuron degeneration. Diabetic sensory neurons develop neuronal atrophy alongside a series of messenger ribonucleic acid ( RNA ) changes related to declines in structural proteins, increases in heat shock protein, increases in the receptor for advanced glycation end‐products, declines in growth factor signaling and other changes. Insulin is recognized as a potent neurotrophic factor, and insulin ligation enhances neurite outgrowth through activation of the phosphoinositide 3‐kinase–protein kinase B pathway within sensory neurons and attenuates phenotypic features of experimental  DPN . Several interventions, including glucagon‐like peptide‐1 agonism, and phosphatase and tensin homolog inhibition to activate growth signals in sensory neurons, or heat shock protein overexpression, prevent or reverse neuropathic abnormalities in experimental  DPN . Diabetic sensory neurons show a unique pattern of micro RNA  alterations, a key element of messenger  RNA  silencing. For example, let‐7i is widely expressed in sensory neurons, supports their growth and is depleted in experimental  DPN ; its replenishment improves features of  DPN  models. Finally, impairment of pre‐messenger  RNA  splicing in diabetic sensory neurons including abnormal nuclear  RNA  metabolism and structure with loss of survival motor neuron protein, a neuron survival molecule, and overexpression of  CWC 22, a splicing factor, offer further novel insights. The present review addresses these new aspects of  DPN  sensory neurodegeneration.

Diabetic neuropathy and the sensory neuron: New aspects of pathogenesis and their treatment implications