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Diabetic Neuropathy – Glycaemic Control — SCE Neurology MCQ

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EasyPeripheral Neuropathy & NeuromuscularDiabetic Neuropathy – Glycaemic ControlSCE Neurology

A 65-year-old man with type 2 diabetes presents with progressive bilateral burning foot pain, worse at night, and autonomic symptoms including erectile dysfunction and postural dizziness. NCS show a length-dependent axonal sensorimotor neuropathy. HbA1c is 9.2% (77 mmol/mol). What is the most important intervention to slow progression of his diabetic neuropathy?

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Correct answer: B — Improve glycaemic control

Optimising glycaemic control is the single most important intervention to slow progression of diabetic peripheral neuropathy. The DCCT/EDIC trial (type 1 diabetes) and UKPDS (type 2 diabetes) demonstrated that intensive glycaemic control significantly reduces the development and progression of neuropathy. Symptomatic treatment for neuropathic pain (gabapentin, pregabalin, duloxetine, amitriptyline) is important for quality of life but does not modify disease progression. A: Gabapentin treats symptoms but does not alter progression. C: B12 should be checked (especially if on metformin) but is not the primary intervention. D: Biopsy is not needed with a clear clinical picture. E: IVIg is not used for diabetic neuropathy.

Reference: NICE NG19 Diabetic Foot (2015); EAN Diabetic Neuropathy Guidelines