Diabetic neuropathy (DN) is prevalent in diabetic patient all over the world including China. Pain is one of its most serious symptoms. New horizon in the diagnosis of painful DN is associated with small fiber nerves (C type). Corneal confocal microscopy was conducted in Chinese cohort to identify the normal reference range and distinguish pre-clinical small fiber neuropathy. Current perception threshold (CPT) was also used for detecting injury in different nerves in community cohort. Beyond these new technology, several serum markers were found in DN patients to be associated with the progression and symptoms of DN, like neurofilament heavy chain, C-peptide and other inflammation markers, like neutrophil-to lymphocyte ratio. On the other hand, Sudoscan was found in Chinese people not only to reflect the function of autonomic nerves system, but also the indicator of diabetic microvascular complications, including DN. Despite of the progression of early diagnosis of DN, we are still lack of effective methods for its treatment because of the ambiguity recognition to its mechanism. Central nerve system is found to play an important role in DN, especially in pain. Our results showed that microglia in both cortex and thalamus were significantly activated in STZ induced T1D rats’ brain in vivo. Glucagon like peptide 1 could improve the inappropriate activation of microglia, induced by both LPS and high glucose, and re-balance its M1/M2 polarization in vitro. Other than glucose control, exercises were believed to be another way for the improvement of DN. Continuous resistive exercises for 6 months had shown its power in Chinese old community diabetic population. With the deepening of the understanding of DN, new techniques and methods will emerge in the diagnosis and control.