Himeno Tatsuhito, Nakai-Shimoda Hiromi, Hayashi Yusuke, Matsumae Akihiro, Kamiya Hideki, Nakamura Jiro, Matsumae Hiromi
Division of Diabetes, Department of Internal Medicine, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan.
Matsumae Internal Medicine Clinic, Ichinomiya, Japan.
Diabetol Int. 2025 Jun 3;16(3):586-590. doi: 10.1007/s13340-025-00824-y. eCollection 2025 Jul.
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.
本报告涉及一名51岁男性患者，其因全身疼痛为主诉前来就医。他的症状大约在六个月前开始，最初表现为双下肢感觉异常，最终发展为全身性弥漫性疼痛。值得注意的是，他在几年内体重显著减轻了约25千克，因此对糖尿病进行了检查。随后的评估显示糖化血红蛋白（HbA1c）水平为7.6%，随机血糖水平为188毫克/分升，同时伴有增殖前期糖尿病视网膜病变的表现，最终确诊为糖尿病。神经生理学评估根据 Baba 分类将糖尿病性多发性神经病变（DPN）的严重程度评为3期。治疗措施包括使用利格列汀控制血糖，使用米罗加巴喷丁和度洛西汀缓解疼痛。糖化血红蛋白水平平均维持在6.2%左右，实现了血糖稳定。与疼痛性DPN相关的主观症状逐渐改善，治疗开始约一年后疼痛症状消失；然而，以双足尖感觉减退为典型表现的残余感觉神经病变缺陷仍然存在。
