Design: Systematic review and meta-analysis of randomised trials
Population: Nine trials in adults with type 2 diabetes
Primary outcome: Incident diabetic peripheral neuropathy
Effect: Intensive glycaemic control: OR 0.93 (95% CI 0.85 to 1.02), four trials

A systematic review of randomised trials asked whether targeting modifiable risk factors prevents peripheral neuropathy in type 2 diabetes. Nine trials had usable data, eight at low risk of bias.

Pooling five glycaemic trials gave an odds ratio of 0.89 (95% CI 0.66 to 1.19), with high heterogeneity driven by BARI-2D, which compared drug strategies rather than glucose targets. Without it, intensive control made little or no difference (OR 0.93, 0.85 to 1.02). Single trials hinted that blood pressure lowering and multifactorial care may help, with low certainty.

This matches what clinicians see: neuropathy progresses in many patients with good HbA1c. Glycaemic control still matters for other complications, but it is not enough on its own to protect the feet.

Examine the feet with monofilament and vibration testing every year, whatever the HbA1c
Control blood pressure and lipids alongside glucose in type 2 diabetes
Advise stopping smoking and moderating alcohol, both linked to neuropathy
Check vitamin B12 in patients on long-term metformin who develop neuropathic symptoms

Why it matters

It removes a common reassurance — that good glucose control alone will protect the nerves.

The statistics, in plain English

An odds ratio of 0.93 with an interval of 0.85 to 1.02 crosses 1.0, so the trials are consistent with a small benefit or none. Removing one very different trial cut heterogeneity from 78% to 23%, which makes the pooled answer more trustworthy.