26th April 2024

A 58-year-old woman with a 15-year history of type 2 diabetes presents with a 9-month history of burning pain in her feet, worse at night.

A 58-year-old woman with a 15-year history of type 2 diabetes presents with a 9-month history of burning pain in her feet, worse at night. She also reports some numbness and a tingling sensation in the same area. Her diabetes has been moderately controlled with oral hypoglycemic agents. On examination, there is reduced sensation to light touch and temperature in a ‘stocking’ distribution. Her ankle reflexes are diminished.

Investigations:

Fasting blood glucose: 8.2 mmol/L (3.9–5.6)

HbA1c: 7.5% (Normal <5.7%)

Nerve conduction studies: Reduced amplitude and conduction velocity in peripheral nerves

Which is the most likely cause of her presentation?