This study addresses these critical knowledge gaps by providing comprehensive validation of NSE as a biomarker for diabetic neuropathy in an Indian population. This study aims to assess the correlation between serum neuron-specific enolase (NSE) levels and the presence and severity of peripheral neuropathy, while also exploring its potential association with autonomic neuropathy as evaluated through standardised cardiovascular autonomic reflex tests. Here, ENO2 is linked to diabetic neuropathy.