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Diabetic Polyneuropathy — RACP Adult Medicine MCQ

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EasyEndocrinologyDiabetic PolyneuropathyRACP Adult Medicine

A 55-year-old man with type 2 diabetes presents with symmetric burning pain and numbness in his feet in a stocking distribution, progressing proximally. Ankle reflexes are absent. NCS shows length-dependent sensorimotor axonal polyneuropathy. HbA1c is 80 mmol/mol. What is the most likely type of neuropathy?

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Correct answer: C — Diabetic distal symmetric polyneuropathy

Symmetric stocking-distribution sensory (painful) neuropathy with absent ankle reflexes and length-dependent axonal pattern on NCS in poorly controlled diabetes is diabetic distal symmetric polyneuropathy — the most common form of diabetic neuropathy (~50% of diabetic patients). Pain management: duloxetine, pregabalin, or amitriptyline. Glycaemic optimisation slows progression. Screen for other treatable causes (B12, thyroid, alcohol).

Reference: ADS – 2024 – Diabetic Neuropathy; eTG Neurology 2024