Muscle Wasting in Diabetes: A Case Report Evaluating a Rare Neuropathic Complication of Diabetic Microvasculitis

Proximal lower extremity weakness in patients with diabetes mellitus presents a diagnostic challenge due to overlapping etiologies, including diabetic amyotrophy, lumbar radiculopathy, and chronic inflammatory demyelinating polyneuropathy (CIDP). This report presents the case of an 80-year-old male with a history of type 2 diabetes mellitus who experienced recurrent falls, progressive right thigh weakness, and muscle atrophy. Although the clinical presentation initially suggested diabetic amyotrophy, electrodiagnostic studies and imaging failed to support this diagnosis. Instead, findings were more consistent with peripheral neuropathy and possible focal L5 radiculopathy. This case highlights the limitations of current diagnostic frameworks for diabetic amyotrophy, particularly in atypical presentations that lack classic features such as pain and characteristic electromyographic abnormalities. The absence of standardized diagnostic criteria necessitated a diagnosis of exclusion, emphasizing the importance of clinical judgment. This report underscores a structured approach to evaluating diabetic patients with lower extremity weakness, including the role of a comprehensive workup, the exclusion of diagnoses with similar presentations, and the potential for recovery through supportive care.