Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between 8.0% and 9.0% before implementing significant lifestyle changes and transitioning to insulin therapy from metformin therapy 2 years ago.
His medical history includes coronary artery disease, first-degree atrioventricular block, nonproliferative diabetic retinopathy, hypertension, and hyperlipidemia.
Medications are regular insulin, neutral protamine Hagedorn (NPH) insulin, aspirin, metoprolol, atorvastatin, and lisinopril.
On physical examination, findings are compatible with distal polyneuropathy.
A review of the patient’s laboratory studies shows a normal complete blood count including erythrocyte indices.
Which of the following is the most appropriate management of this patient’s neuropathy?
A. Amitriptyline
B. Duloxetine
C. Nerve conduction study
D. Vitamin B12 measurement
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