Gray Areas: Realistic Possibility of Reversing Diabetic Neuropathy

Neurology moves fast, and the assumptions that shape how we practice do not always keep up. Gray Areas is a NeurologyLive series where leading clinicians and researchers challenge widely held beliefs across neurology, unpacking what the evidence actually shows, where it falls short, and where the field still has a lot of figuring out to do.

At the 2026 Peripheral Nerve Society (PNS) Annual Meeting, held June 13-16 in Maastricht, the Netherlands, Brian Callaghan, MD, MS, professor of neurology at the University of Michigan, presented in a debate session centered on one of the more contested questions in neuromuscular medicine: is diabetic peripheral neuropathy (DPN) actually reversible if treated early enough? It is a question the field has been circling for years, and one that does not yet have a clean answer.

In this episode, Callaghan breaks down where the concept of DPN reversibility came from, what the data does and does not support, where the research needs to go next, and what the broader neuromuscular community actually thinks about whether this goal is achievable. Here is what he had to say.

Timeline

Segment 1: The Myth (1:15 - 1:45) — Dr. Callaghan sets up the core debate, exploring where the concept of reversing DPN originated and why the biology of peripheral nerves makes this such a contested goal.

Segment 2: What the Evidence Shows (1:45 - 2:25) — A look at what the data actually supports, including lessons borrowed from other nerve conditions and why early treatment timing may matter more than previously understood.

Segment 3: Clinical Implications (3:30 - 4:30) — Dr. Callaghan outlines what a meaningful path toward reversibility could look like, including the role of GLP-1 medicines and a multifactorial treatment approach targeting glucose, obesity, blood pressure, and lipids.

Segment 4: Taking the Temperature (4:30 - 5:25) — A candid look at where the neuromuscular community actually stands on this debate, including a real-time poll from the PNS meeting that revealed a significant divide in opinion.

Segment 5: What We Still Don't Know (5:30 - 7:00) — The five to ten year outlook for DPN reversibility, and why closing the early diagnosis gap may be just as important as developing better therapies.