BACKGROUND: Unattended diabetic neuropathy (DN) significantly contributes to lower limb amputations and diminished quality of life, making diabetes mellitus (DM) management a global public health concern. Altered expression levels of long noncoding RNA (lncRNA) may play a pivotal role in neuropathy in diabetic conditions potentially linking hyperglycaemia-induced inflammation and oxidative stress. The current study investigated whether the expression levels of long non-coding RNAs (lncRNAs) can serve as potential biomarkers for the early identification of subclinical diabetic neuropathy (DN) in type 1 diabetes (T1DM) patients. METHODS: Cellular, physiological, and systemic parameters alongside differential lncRNA expression in the blood of T1DM patients with and without subclinical neuropathy, confirmed via Quantitative Sensory Testing (QST) and In Vivo Corneal Confocal Microscopy (IVCCM) compared to age-matched healthy siblings were analysed from a government hospital. Healthy siblings (n = 20) served as controls with no diabetes or neuropathy. Diabetes participants were categorised into groups with neuropathy T1DN (n = 21) and without neuropathy T1DM (n = 22). LncRNA expression from peripheral blood mononuclear cells (PBMCs) was determined by Quantitative Real-Time PCR (qRT-PCR). Intracellular and mitochondrial reactive oxygen species (ROS), inflammatory protein markers, and endogenous oxidative stress parameters were evaluated from PBMCs and serum. Statistical analyses were performed using SPSS statistics version 20 and GraphPad Prism version 8.0.1. RESULTS: Significant upregulation of lncRNAs XIST, NEAT1, MALAT1, and DLX6AS, along with distinct expression profiles of PVT1, TUG1, IGF2AS, and MEG3, were observed between T1DM and T1DN groups. Notably, MALAT1, NEAT1, XIST, and DLX6AS exhibited marked upregulation (p < 0.001), while MEG3 was significantly downregulated (p < 0.001), with high specificity demonstrated by Receiver Operating Characteristics (ROC) curve analysis. Diabetic neuropathy (DN) patients exhibited significant levels of elevated intracellular and mitochondrial ROS. The inflammatory milieu was also noted to be significantly perturbed. CONCLUSION: LncRNAs are novel and more reliable genomic imprints, as per expensive IVCCM, used to study the functional and structural changes in small nerve fibres. The identified lncRNA expression patterns may serve as predictive markers for early detection and monitoring of the risk of diabetic neuropathy in DM.