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Aim To evaluate the changes in quality of life (QOL), diabetic neuropathy (DN) and amputations over 4 years in patients with diabetes. Methods In 2012, 25,000 Romanian‐translated Norfolk QOL‐DN self‐administered questionnaires were distributed during a cross‐sectional study. Between March‐December 2016, all patients identified from the 2012 cohort and enrolled in this follow‐up study completed the Norfolk QOL‐DN questionnaire; amputations suffered since 2012 were recorded. The influence of age and duration of diabetes (DD) on delta QOL scores (defined as the differences between 2012 and 2016 scores) and of sex, age, diabetes type, DD and declared DN on amputations was explored using multivariate linear and logistic regression, respectively. Results The mean (standard deviation) age of the 1865 participants was 60.6 (10.3) years. Mean total QOL‐DN score increased from 2012 to 2016 by 4.39% (P = .079). Both DD (b = 0.39, 95% confidence interval [CI] 0.21‐0.57, P < .001) and age (b = 0.25, 95% CI 0.13‐0.36, P < .001) were significantly correlated with total QOL‐DN score. Delta total QOL was higher in patients whose statement about having DN changed since 2012. Over 4 years, 36 patients suffered amputations. Male sex (OR = 3.11, 95% CI 1.46‒6.62, P = .003), physical functioning/large‐fibre neuropathy subscale score (OR = 1.04, 95% CI 1.001‒1.09, P = .047), autonomic neuropathy subscale score (OR = 0.78, 95% CI 0.64‒0.94, P = .011) and small‐fibre neuropathy subscale score (OR = 1.21, 95% CI 1.05‒1.40, P = .007) were significant predictors of amputations. Delta total QOL‐DN score was 10 times higher in patients who suffered amputation(s) compared with their amputation‐free counterparts. Conclusion QOL deteriorates with age and DD. Norfolk QOL‐DN subscale scores can predict amputations.