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Diabetic lumbosacral radiculoplexus neuropathy after glucagon-like peptide 1 receptor agonist use: A case series
Swathy Chandrashekhar1, Long Davalos2, Richeek Pradhan3
1Neuromuscular Division, Department of Neurology, University of California San Francisco, USA.
Background:
Diabetic Lumbosacral Radiculoplexus Neuropathy (DLRPN) is a rare form of debilitating neuropathy, usually preceded by rapid glycemic control.
Methods:
We describe a case series of patients with DLRPN who had been exposed to GLP-1 Receptor Agonists (GLP-1 RA) prior to symptom onset.
Results:
Six patients (3 men; aged 53-73) with type 2 diabetes developed sudden-onset, asymmetric lower limb pain followed by weakness-bilateral in 5/6. Most had substantial weight loss (35-52 lbs) and rapid HbA1c decline (>5) in months preceding symptoms. Four patients had electrophysiologic evidence of lumbosacral plexopathy; imaging was supportive in 2. One patient received intravenous steroids with improvement; others were managed supportively, with 3 showing stabilization or mild recovery.
Discussion:
This series highlights a potential association between rapid glycemic and weight changes from GLP-1 RA use and DLRPN. Clinicians should be alert to subacute neuropathy with muscle weakness in patients undergoing aggressive glycemic control.
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