SUN-609 Diabetic Amyotrophy: A Rare And Debilitating Complication Of Diabetes Mellitus

Abstract Disclosure: R. Katmawi Sabbagh: None. A. Chhoker: None. Diabetic Amyotrophy: A Rare and Debilitating Neurologic Complication of Diabetes Background: Diabetic amyotrophy is a rare but disabling complication of diabetes, affecting ∼1% of patients. It typically presents with acute, asymmetric proximal lower extremity pain followed by weakness, often with associated weight loss and autonomic symptoms. The condition most often begins unilaterally but can progress to bilateral involvement. Though its exact pathophysiology is unclear, ischemic injury, axonal degeneration, and microvasculitis are implicated. Diagnosis is clinical and by exclusion, often supported by EMG and nerve conduction studies showing axonal loss and denervation. Treatment remains supportive, focused on glycemic control, pain management, and physical rehabilitation. Clinical Case: A 55-year-old man with a history of type 2 diabetes (HbA1c 10%), hypertension, hyperlipidemia, and OSA presented with progressive lower extremity pain and weakness over 3 months. Symptoms began with aching in the right anterior thigh, extending to the right gluteal region and eventually involving the contralateral thigh. Weakness followed, especially in the quadriceps and gluteal muscles, leading to impaired mobility and wheelchair dependence. Neurologic exam demonstrated bilateral proximal lower limb weakness with reduced sensation in the lower extremities. MRI of the lumbar, thoracic, and cervical spine showed no structural abnormalities. EMG revealed prolonged distal latency and low amplitude in the bilateral fibular nerves.. The patient was started on gabapentin and insulin for glycemic control, with improvement in pain but minimal strength recovery while inpatient. He was discharged with plans for outpatient physical and occupational therapy. On follow up few months later, Patient was with A1c ranging between 5.5-6.5. Clinically, his symptoms significantly improved. He no longer was wheelchair dependent and his pain has significantly improved. Conclusion: Diabetic amyotrophy is an underdiagnosed but severe proximal diabetic neuropathy. It often mimics lumbar radiculopathy and can be misattributed, delaying treatment. While no disease-modifying therapy exists, early diagnosis and supportive care, including tight glycemic control and rehabilitation, can improve outcomes. Increased awareness is critical as diabetes prevalence rises worldwide. References: 1.Subacute diabetic proximal neuropathy - PubMed (nih.gov)2.Successful treatment of neuropathies in patients with diabetes mellitus - PubMed (nih.gov) Presentation: Sunday, July 13, 2025