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The most common form of peripheral nervous system damage in diabetes mellitus is distal symmetric sensorimotor polyneuropathy (DSSMPN). Chronic hyperglycemia, dyslipidemia, and impaired microcirculation are considered to be the key mechanisms for the development of DSSMPN, but its pathogenesis is still unclear and continues to be studied. The paper analyzes the issues of diagnosis of DSSMPN and the effective principles of patient treatment. It also discusses the use of alpha-lipoic acid (ALA) as a drug for the pathogenetic treatment of DSSMPN and describes the results of clinical trials of its treatment with ALA preparations.