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 ¹ (Izenberg et al., 2015; Boulton, 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., 2015; Boulton, 2023).