Diabetic polyneuropathy is a frequent complication of diabetes mellitus, with a tremendous impact not only on quality of life but also on the development of other complications, e.g. diabetic foot syndrome. At present, only one causal therapy is available, namely intensified metabolic control, which is apparently more effective as a prophylaxis than as a treatment of existing neuropathic disturbances. Based on hypothetical mechanisms mainly generated from experimental diabetic neuropathy in rodents, a large number of substances have been tested in clinical trials, although none has as yet been introduced into daily practice. Recommendations for the treatment of neuropathic pain are firmly based on the meta-analytic results of randomized controlled trials and provide successful treatment for most patients. New substances introduced during the last years may help to properly select individual treatment.