Endocrine Abstracts

JOINT507

Introduction: Diabetic neuropathy (DN) is one of the most common complications of diabetes, affecting approximately 50% of patients, typically after 5 years of type 1 diabetes (T1DM). DN is associated with increased risks of falls, fractures, amputations, high economic costs, and a significant reduction in quality of life.

Case Presentation: We report the case of a 17-year-old male diagnosed with brittle T1DM 4 years ago. His diabetes has been poorly controlled, with frequent hospitalizations due to diabetic ketoacidosis and recurrent severe hypoglycemic episodes. Contributing factors include recurrent infections, lipodystrophy at insulin injection sites, and psychological factors such as denial of the disease and treatment non-adherence. His HbA1c was 17%. The patient presented with paresthesia in all four limbs, scoring 4/10 on the Douleur Neuropathique 4 (DN4) questionnaire. Neurological examination revealed errors on the monofilament test, indicating neuropathy, though there were no significant sensory or motor deficits. Electromyography (EMG) confirmed early-stage sensory-motor axonal neuropathy with conduction blocks and bilateral carpal tunnel syndrome. No other diabetes-related complications, such as retinopathy, were detected. Other causes of neuropathy, including vitamin B12 deficiency, thyroid dysfunction, and renal failure with electrolyte imbalance, were excluded. Symptoms significantly improved with optimized glycemic control and the initiation of amitriptyline (10 mg/day).

Discussion: According to Yoon Hi Cho et al., approximately 16% of patients with newly diagnosed T1DM within 2 to 5 years develop diabetic neuropathy. Hyperglycemia is the primary risk factor for DN, and both the duration of diabetes and poor glycemic control contribute significantly to nerve damage. Additionally, the neurotrophic action of insulin is deficient even in the early stages of T1DM, contributing to the development of neuropathy. Maintaining rigorous glycemic control from the onset of diabetes is essential to prevent or delay the development of neuropathic complications.

Conclusion: Early screening for diabetic neuropathy should be considered even in patients with recent-onset T1DM, as early intervention with glycemic optimization and symptomatic treatment can improve outcomes and prevent further complications.