The Role of Exercise in Managing Diabetes-Induced Neuropathy

Innovations in Diabetes & Metabolic Care | Spring 2025

It is estimated that 20 million Americans are living with diabetic neuropathy, a condition that affects patients with both type 1 and type 2 diabetes mellitus.

Claudia Lewis, MMS, PA-C

Clare Kelly, MD

According to a position statement released by the American Diabetes Association (ADA), diabetic neuropathy is the most prevalent chronic complication of diabetes. Affecting up to 50 percent of patients over their lifetime, the progressive condition is characterized by nerve damage due to chronic hyperglycemia, oxidative stress and microvascular dysfunction. The prevalence of diabetic neuropathy increases with disease duration, poor glycemic control and comorbidities such as hypertension and dyslipidemia.

Peripheral neuropathy is the most common form, often manifesting as pain and sensory loss. “Structural changes in small blood vessels reduce the supply of oxygen and nutrients to the nerves,” says Claudia Lewis, MMS, PA-C, an endocrinology associate physician assistant within the University Hospitals Diabetes & Metabolic Care Center. “This is often referred to as stocking-glove neuropathy because the numbness and tingling start in toes and fingertips and move upward.”

The Importance of Early Diagnosis

Roughly half of diabetic neuropathy is asymptomatic. Early recognition and appropriate management are essential to minimize the risk of infection or injury due to lack of sensation. “I had a patient who sustained severe burns to the feet because of the inability to recognize that the water was hot,” says Clare Kelly, MD, an endocrinologist within the UH Diabetes & Metabolic Care Center. “We typically think of ulcers that do not heal, but neuropathy contributes to a range of health complications.”

Patients should be evaluated for fall risks. “Neuropathy affects patients’ ability to sense their feet in space, which leads to increased falls. That is of particular concern for endocrinologists because we treat osteoporosis,” Dr. Kelly says. “Especially when caring for elderly patients who may have advanced diabetes, it is important to assess foot health and fall risks because we don’t want people to sustain a fracture or other injury.”

Exercise as Treatment

The American Heart Association recommends 150 minutes per week of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity. “These guidelines provide people with helpful benchmarks for incorporating exercise that has been shown to increase insulin sensitivity, lower blood glucose and lower cholesterol,” Lewis says. “The systemic benefits of exercise have a domino effect in preventing or reducing the complications of diabetic neuropathy.”

A multifaceted approach to exercise can improve core strength and gait to protect against fall-related injuries. “Encouraging aerobic and sensory-motor exercises has been shown to prevent neuropathy worsening and improve balance,” Dr. Kelly says. “Additionally, the literature tells us that engaging in exercise helps decrease stress, improves psychological well-being and positively impacts quality of life.”

Person-centered Care

Specialists within the UH Diabetes & Metabolic Care Center focus on providing a comprehensive and holistic philosophy to diabetes medicine, empowering individuals with the tools and education they need.

“We want to encourage our patients with neuropathy to keep moving, and we incorporate a multidisciplinary treatment approach that includes exercise plans, podiatry, physical therapy and nutrition counseling to support them,” Lewis says. She adds that the team holds diabetes education patient retreats throughout Northeast Ohio communities, providing a half-day of informational and exercise sessions.

For Dr. Kelly, the goal is to guide patients to a place where they are comfortable taking the lead with their health. “I am always there for people, but diabetes is a chronic disease that requires daily management,” she says. “I want to transition from coach to spectator because my patients are so knowledgeable about their disease that they have taken over that role.”

For more information, contact Dr. Kelly at Clare.Kelly@UHhospitals.org.

Contributing Experts:
Clare Kelly, MD
Endocrinologist
University Hospitals Diabetes & Metabolic Care Center
University Hospitals Cleveland Medical Center
Assistant Professor
Case Western Reserve University School of Medicine

Claudia Lewis, MMS, PA-C
Endocrinology Associate Physician Assistant
University Hospitals Diabetes & Metabolic Care Center
University Hospitals Cleveland Medical Center