Whether nerve fiber loss, a prominent feature of advanced diabetic neuropathy, may be reversed by reestablishment of normal glucose control remains questionable. We present 8-year follow-up data on epidermal nerve fiber (ENF) density and neurological function in patients with type 1 diabetes after simultaneous pancreas/kidney transplantation (SPK) with long-term normoglycemia. Distal thigh skin biopsies with ENF counts, vibration perception thresholds (VPT), autonomic function testing (AFT), and electrophysiological examinations were performed at time of SPK and 2.5 and 8 years post-SPK in 12 type 1 diabetic patients. In comparison with controls baseline ENF density, VPT and AFT results of patients indicated severe neuropathy. At follow-up, all SPK recipients were insulin-independent with excellent glycemic control and kidney graft function. However, the severe ENF depletion present at baseline had not improved with total ENF absence in 11 patients at 8-year follow-up. Similarly, no amelioration occurred in the VPT and AFT results. Numerical improvement was seen in some electrophysiological parameters; however, statistical significance was achieved in median motor nerve conduction velocity only. Epidermal nerve fiber loss and functional deficits in advanced diabetic peripheral neuropathy are poorly reversible even by long-term normoglycemia which underscores the importance of neuropathy prevention by early optimal glycemic control. This article is protected by copyright. All rights reserved.