What are the key clinical features to consider when diagnosing diabetic amyotrophy in a patient with diabetes?

Key clinical features to consider when diagnosing diabetic amyotrophy in a patient with diabetes include:

• Onset and pattern of symptoms: Typically presents with acute or subacute onset of severe unilateral or asymmetric proximal lower limb pain followed by progressive weakness and muscle wasting, especially affecting the thigh and hip muscles.
• Distribution: Predominantly involves the femoral nerve distribution, leading to difficulty in hip flexion and knee extension, often accompanied by weight loss.
• Neurological signs: Muscle weakness and atrophy in proximal lower limbs, with reduced or absent deep tendon reflexes in the affected areas; sensory symptoms such as numbness or paresthesia may be present but are usually less prominent than motor deficits.
• Systemic features: Often occurs in patients with type 2 diabetes and may be associated with recent poor glycaemic control or other diabetic complications.
• Exclusion of other causes: Important to rule out other causes of proximal neuropathy or myopathy, including lumbar radiculopathy or inflammatory myopathies.

These features reflect a diabetic lumbosacral radiculoplexus neuropathy characterized by asymmetric proximal weakness and pain, distinguishing it from other diabetic neuropathies which are typically distal and symmetric NICE NG19 Izenberg et al. 2015Boulton 2023. The acute painful onset with subsequent muscle wasting and weakness is a hallmark clinical presentation emphasized in both UK guidelines and recent literature Izenberg et al. 2015Boulton 2023.