Diabetic amyotrophy is a complication of diabetes mellitus. Affected individuals suffer from painful, progressive damage to the lumbosacral plexus and consequent neurological deficits.
Initially, DA manifests in form of severe, unilateral pain in buttocks, hips, and thighs. Similar symptoms subsequently affect the contralateral side. Patients then develop a progressive, asymmetric weakness of the lower limbs. As the disease progresses, patients may experience bouts of acute exacerbation and distal parts of the legs may become involved  . Paresthesia may be noted in distal portions of the legs. In the long term, muscle atrophy can be observed in affected regions. In severe cases, patients may become wheelchair-dependent.
Autonomic function impairment has repeatedly been described in DA patients and may comprise orthostatic hypotension, diarrhea or constipation, and sexual dysfunction. Compromise of the brachial plexus, cervical and thoracic radiculopathy have been reported  . Neurological symptoms are often accompanied by general weight loss. Of note, patients may also claim polyuria and polydipsia, recurrent infections and retarded wound healing as well as diabetic foot ulcer, diabetic retinopathy, and diabetic nephropathy. These symptoms are not characteristic of DA but are frequently observed in diabetes mellitus patients.
After several weeks of illness, symptoms usually subside spontaneously. However, some patients do not achieve complete recovery.
The observation of characteristic symptoms in a diabetic patient is the basis of the diagnosis of DA. DA may well be the first symptom of diabetes mellitus and thus, some patients may not have been previously diagnosed with this disease. In any case, measurements of fasting blood glucose and hemoglobin A1C (HbA1C) levels should be performed. Results may demonstrate poor glycemic control or prompt a suspicion of undiagnosed diabetes mellitus. As for the latter, glucose tolerance tests are indicated to establish the respective diagnosis.
Complementary diagnostic measures may be conducted as follows:
Diabetic amyotrophy (DA) is also known as proximal diabetic neuropathy or lumbosacral radiculoplexus neuropathy and refers to a complication of diabetes mellitus type 2 or, less commonly, diabetes mellitus type 1 . About 1% of individuals suffering from diabetes mellitus develop DA . This condition is assumed to result from an immune-mediated vasculopathy and ensuing nerve ischemia . However, the precise cause of the presumed immune disorder remains unknown. DA patients don't usually have a medical history of autoimmune disease.
DA affects the lumbosacral plexus and emerging nerves, and thus interferes with motor control and sensation in the pelvic region and proximal parts of the legs. Contrary to the more common distal neuropathy of diabetes mellitus patients, motor deficits prevail in individuals affected by DA. Due to the underlying inflammation, the condition is painful. Treatment primarily consists of an appropriate glycemic control, although anti-inflammatory medication has occasionally been administered  . Patients may also benefit from physical therapy .