Partial Lipodystrophy of Limbs in Type 2 Diabetes

Abstract

Rationale: On account of the diversity and rarity of lipodystrophy, this condition may be frequently unrecognized or misdiagnosed. This tends to be concerning as it is progressive and has potentially life-threatening complications. Patient Concerns: The patient was referred to our clinic with chief complaints of uncontrolled glycemia and an increased frequency of urination since last 3 months. The patient complained of weakness that led to thinning of upper limb muscles, loss of fat from face, neck, and upper thorax with simultaneous increase in abdominal girth, flattening of buttocks, and reduction in girth of lower limb muscles. Diagnosis: The patient was diagnosed with partial lipodystrophy of limbs (PLL) based on unique clinical features, blood investigations, and a DEXA fat scan. Interventions: The patient was treated with basal insulin glargine, metformin 1.5 g, dapagliflozin 10 mg, pioglitazone 7.5 mg, and atorvastatin 40 mg. He was vigorously educated to follow a strict diet and an exercise plan with necessary lifestyle modifications. Outcomes: After 3 months, the patient achieved better glycemic control with a reduction in HbA1c from 9.5% to 7.2%, as well as an improvement in lipid profile. He additionally achieved a weight reduction of 12 kg, with reduction in his abdominal girth from 130 to 118 cm. Lessons: The recognition of PLL in patients with type 2 diabetes can help better clinical management by alerting physicians to the associated comorbidities. Many a times, PLL goes unnoticed on account of the slow progression. Our case highlights the need for greater recognition of PLL as it has specific metabolic features that help in guiding appropriate clinical management.