A case report: preceding diagnosis of type 2 diabetes by severe neuropathic pain arising from diabetic polyneuropathy.

Abstract

This report pertains to a 51-year-old male patient who sought medical attention with the chief complaint of generalized bodily pain. His symptoms commenced approximately six months prior, characterized initially by paresthesia in both lower extremities, eventually evolving into diffuse systemic pain. Noteworthy was his history of a significant weight reduction of approximately 25 kg over the span of several years, prompting investigation for diabetes mellitus. Subsequent assessments revealed an HbA1c level of 7.6% and a random blood glucose level of 188 mg/dl, coupled with findings indicative of pre-proliferative diabetic retinopathy, culminating in a diagnosis of diabetes mellitus. Neurophysiological evaluation graded the severity of diabetic polyneuropathy (DPN) as Stage 3 according to the Baba classification. Management encompassed glycemic control with linagliptin and pain mitigation with mirogabalin and duloxetine. Glycemic stability was achieved with HbA1c levels averaging around 6.2%. Gradual amelioration of subjective symptoms associated with painful DPN ensued, with positive pain manifestations resolved approximately one year post-initiation of therapy; however, residual sensory neuropathic deficits, typified by diminished sensation in both toe tips, persisted.