A 38-year-old man with type 1 diabetes for the past 24 years comes to the physician due to pain in his feet. He describes burning pain in both feet involving the toes and forefoot. On examination, blood pressure is 145/86 mm Hg and pulse is 78/min. His hemoglobin A1c values in the past 2 years have ranged from 9%-10%. Which of the following statements is most accurate regarding this patient's diabetic neuropathy?

Question

A 38-year-old man with type 1 diabetes for the past 24 years comes to the physician due to pain in his feet.  He describes burning pain in both feet involving the toes and forefoot.  On examination, blood pressure is 145/86 mm Hg and pulse is 78/min.  His hemoglobin A1c values in the past 2 years have ranged from 9%-10%.  Which of the following statements is most accurate regarding this patient's diabetic neuropathy?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c135_035b_8f63_9b2c80a8660c_MD0005_00 Suboptimal diabetic control is associated with higher risk of painful diabetic neuropathy in both type 1 and type 2 diabetes mellitus. In type 1 diabetes, strict control (hemoglobin A1c <7%) can decrease the incidence of new neuropathy by up to 70%. It also appears to slow progression of early diabetic neuropathy. The evidence that strict glycemic control prevents neuropathy in type 2 diabetes is weaker, but well-established benefits in preventing other microvascular complications (ie, nephropathy, retinopathy) warrant strict control in these patients as well. (Choice A) Metabolic factors other than glycemic control, such as hyperlipidemia, hypertension, smoking, and obesity, may also play a role in the development of neuropathy. However, there is only limited data to show that improving non-glycemic metabolic factors prevents or reverses diabetic neuropathy. (Choice B) Symptoms of painful diabetic neuropathy will decrease spontaneously in up to 55% of patients. However, remission is most likely when neuropathy is associated with a significant metabolic event, such as ketoacidosis or severe weight loss following bariatric surgery, and is less likely in longstanding diabetes. (Choices C and D) The effect of strict glycemic control in reversing established diabetic neuropathy is unclear; however, it does not appear to worsen preexisting neuropathy. Educational objective: Strict blood glucose control decreases the risk of developing peripheral neuropathy in patients with type 1 and possibly type 2 diabetes. Strict control also appears to slow the progression of neuropathy and decreases the risk of other microvascular complications (ie, nephropathy, retinopathy). References: Enhanced glucose control for preventing and treating diabetic neuropathy. (http://www.ncbi.nlm.nih.gov/pubmed/22696371)

A 38-Year-Old Man with Type 1 Diabetes for the Past