University of Nebraska Medical Center Omaha, Nebraska, United States
Case Diagnosis: Diabetic Amyotrophy
Case Description: 70-year-old man with known history of type 2 diabetes mellitus who presented with progressive bilateral lower extremity weakness, pain, and multiple falls for 9 months. Patient was independently functioning prior and presented wheelchair bound. Notably, he experienced a rapid decline in hemoglobin A1c from 12.6% to 6.2% over four months on glipizide therapy after initial diagnosis of type 2 diabetes mellitus. Infectious, autoimmune, metabolic, and nutritional studies were all negative. MRI demonstrated multilevel spondylosis and moderate diffuse myositis involving gluteal, iliacus, obturator, and adductor muscles – greater on left side. Abnormal EMG with severe bilateral lumbosacral radiculoplexus neuropathy. Patient was trialed on IV steroids with minimal improvement and discharged to acute rehab.
Discussions: Diabetic amyotrophy is a rare but serious complication of diabetes mellitus characterized by painful neuropathy, progressive proximal weakness, and atrophy that mainly affects the thighs and hips. Populations most affected by this are middle-aged and elderly older-aged people with type 2 diabetes mellitus. There is a male predominance. The most notable causes are attributed to poor glycemic control, long duration of diabetes, or rapid glycemic correction. Generally, diabetic amyotrophy is a self-limiting disease that progresses over 6-12 months before plateauing. Symptoms can lasty for up to 18 months with residual deficits lasting longer. Management of diabetic amyotrophy is mainly supportive, focusing on adequate glycemic control, pain management, and physical rehabilitation.
Conclusions: This case highlights the clinical importance of recognizing diabetic amyotrophy, especially in the context of rapid glycemic correction. Clinicians should be cautious when initiating glucose-lowering therapies in patients with chronically elevated A1c with close follow up, as abrupt reductions may precipitate diabetic amyotrophy and associated neuropathies. Early diagnosis of diabetic amyotrophy allows for appropriate supportive management and rehabilitation. While immunotherapy remains controversial, the primary focus is on symptom control, physical therapy, and cautious glycemic optimization.
