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Diabetic peripheral neuropathy — SCE Endocrinology MCQ

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ModerateDiabetes complicationsDiabetic peripheral neuropathySCE Endocrinology

A 62-year-old woman with type 2 diabetes has painful burning feet at night. Vibration sense is reduced, ankle reflexes are absent and monofilament sensation is impaired bilaterally. HbA1c is 71 mmol/mol. What is the most appropriate next investigation?

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Correct answer: B — Check vitamin B12 and renal function while assessing diabetic peripheral neuropathy

Check vitamin B12 and renal function while assessing diabetic peripheral neuropathy is best because distal symmetrical neuropathy is common in diabetes, but reversible contributors such as B12 deficiency and renal impairment should be sought. The alternatives are less appropriate because biopsy and lumbar puncture are for atypical cases; MRI is not first-line without focal signs; no work-up risks missing treatable causes. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG28; NICE NG17