ICD-10: E11.44

ICD-10 code E11.44 refers to Type 2 diabetes mellitus with diabetic amyotrophy, a specific complication associated with diabetes. This condition is characterized by muscle weakness and atrophy, primarily affecting the proximal muscles, which can lead to significant functional impairment. Below is a detailed overview of this condition, including its clinical description, symptoms, diagnosis, and management.

Clinical Description

Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and relative insulin deficiency. It is often associated with obesity, sedentary lifestyle, and genetic predisposition. The condition can lead to various complications, including cardiovascular disease, neuropathy, nephropathy, and retinopathy, among others[1][2].

Diabetic Amyotrophy

Diabetic amyotrophy, also known as diabetic proximal neuropathy or diabetic lumbosacral radiculoplexus neuropathy, is a rare but debilitating complication of diabetes. It primarily affects the muscles of the hips, thighs, and buttocks, leading to weakness and atrophy. The exact pathophysiology is not fully understood, but it is believed to involve ischemic damage to the nerves due to metabolic derangements associated with diabetes[3][4].

Symptoms

Patients with diabetic amyotrophy may experience a range of symptoms, including:

• Muscle Weakness: Typically affects the proximal muscles, leading to difficulty in climbing stairs, rising from a seated position, or lifting objects.
• Pain: Often presents as severe pain in the thighs, hips, or buttocks, which may precede muscle weakness.
• Atrophy: Muscle wasting can occur over time, particularly in the affected areas.
• Sensory Changes: Some patients may report numbness or tingling in the legs, although this is less common than in other forms of diabetic neuropathy[5][6].

Diagnosis

The diagnosis of diabetic amyotrophy involves a combination of clinical evaluation and diagnostic tests:

• Clinical History: A thorough history of diabetes management, symptom onset, and progression is essential.
• Neurological Examination: Assessment of muscle strength, reflexes, and sensory function helps identify the extent of neuropathy.
• Electromyography (EMG) and Nerve Conduction Studies: These tests can help confirm the diagnosis by demonstrating abnormalities in nerve function and muscle response.
• Imaging Studies: MRI may be used to rule out other causes of muscle weakness or pain, such as tumors or structural abnormalities[7][8].

Management

Management of diabetic amyotrophy focuses on controlling blood glucose levels and alleviating symptoms:

• Glycemic Control: Tight control of blood sugar levels is crucial to prevent further nerve damage and improve symptoms. This may involve lifestyle changes, oral hypoglycemic agents, or insulin therapy.
• Pain Management: Analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) or neuropathic pain medications (e.g., gabapentin, pregabalin), may be prescribed to manage pain.
• Physical Therapy: Rehabilitation exercises can help improve muscle strength and function, although care must be taken to avoid overexertion.
• Monitoring and Support: Regular follow-up with healthcare providers is essential to monitor the progression of diabetes and manage any complications effectively[9][10].

Conclusion

ICD-10 code E11.44 encapsulates the complexities of Type 2 diabetes mellitus with diabetic amyotrophy, highlighting the need for comprehensive management strategies. Early recognition and intervention are vital to mitigate the impact of this condition on patients' quality of life. Continuous education on diabetes management and regular monitoring can significantly improve outcomes for individuals affected by this complication.

References

1. International Classification of Diseases, 10th Revision.
2. Coding and Documentation of Diabetes Mellitus in ICD-10.
3. Article - Billing and Coding: Routine Foot Care (A57954).
4. Diabetes Mellitus (DM).
5. SCS-ICD-10-CM-Diagnosis-Coding-Guide-for-DPN.
6. Article - Billing and Coding: Routine Foot Care (A52996).
7. 2025 ICD-10-CM Diagnosis Code E11.40.
8. ICD 10 NCD Manual.
9. Clinical guidelines on the management of diabetic neuropathy.
10. Overview of diabetic complications and their management.

Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by insulin resistance and relative insulin deficiency, leading to elevated blood glucose levels. One of the complications associated with T2DM is diabetic amyotrophy, which is specifically coded as E11.44 in the ICD-10-CM classification. This condition presents with a range of clinical features, signs, symptoms, and patient characteristics that are important for diagnosis and management.

Clinical Presentation of E11.44

Definition of Diabetic Amyotrophy

Diabetic amyotrophy, also known as diabetic lumbosacral radiculoplexus neuropathy, is a type of neuropathy that primarily affects the proximal muscles of the lower limbs. It is characterized by muscle weakness and atrophy, particularly in the thighs and hips, and is often accompanied by pain.

Signs and Symptoms

Patients with diabetic amyotrophy may exhibit the following signs and symptoms:

• Muscle Weakness: Patients often report weakness in the proximal muscles, particularly in the thighs, which can lead to difficulty in climbing stairs or rising from a seated position.
• Pain: A common symptom is severe pain in the hips, thighs, or buttocks, which may be described as burning or aching. This pain can be debilitating and may precede the onset of muscle weakness.
• Atrophy: Muscle wasting may occur over time, particularly in the quadriceps and hip flexors, leading to noticeable changes in muscle bulk.
• Sensory Changes: Some patients may experience sensory disturbances, such as numbness or tingling in the lower extremities, although this is less common than in other forms of diabetic neuropathy.
• Gait Abnormalities: Due to muscle weakness and pain, patients may develop an abnormal gait, which can increase the risk of falls.

Patient Characteristics

Certain characteristics are commonly observed in patients diagnosed with E11.44:

• Age: Diabetic amyotrophy typically occurs in older adults, often between the ages of 50 and 70, although it can occur in younger individuals with long-standing diabetes.
• Duration of Diabetes: Patients often have a history of diabetes for several years before the onset of amyotrophy, with many having poorly controlled blood glucose levels.
• Metabolic Control: Poor glycemic control is a significant risk factor for the development of diabetic amyotrophy. Patients with higher HbA1c levels are more likely to experience this complication.
• Comorbidities: Many patients with diabetic amyotrophy may have other complications of diabetes, such as retinopathy or nephropathy, indicating a more advanced stage of the disease.

Diagnosis and Management

The diagnosis of diabetic amyotrophy is primarily clinical, based on the characteristic symptoms and physical examination findings. Electromyography (EMG) and nerve conduction studies may be utilized to confirm the diagnosis and rule out other neuropathies.

Management Strategies

Management of diabetic amyotrophy focuses on:

• Glycemic Control: Tight control of blood glucose levels is crucial to prevent further complications and promote recovery.
• Pain Management: Analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) and neuropathic pain medications (e.g., gabapentin or pregabalin), may be prescribed to alleviate pain.
• Physical Therapy: Rehabilitation exercises can help improve muscle strength and function, although this should be approached cautiously to avoid exacerbating pain.

Conclusion

Diabetic amyotrophy (ICD-10 code E11.44) is a significant complication of type 2 diabetes mellitus that presents with distinctive clinical features, including muscle weakness, pain, and atrophy in the proximal lower extremities. Understanding the signs, symptoms, and patient characteristics associated with this condition is essential for timely diagnosis and effective management. Early intervention focusing on glycemic control and supportive therapies can significantly improve patient outcomes and quality of life.

ICD-10 code E11.44 refers specifically to Type 2 diabetes mellitus with diabetic amyotrophy. This condition is characterized by muscle weakness and atrophy due to nerve damage associated with diabetes. Understanding alternative names and related terms can help in better communication and documentation in medical settings. Here’s a detailed overview:

Alternative Names for E11.44

1. Diabetic Amyotrophy: This is the most direct alternative name, emphasizing the muscle wasting aspect of the condition.
2. Diabetic Lumbosacral Radiculoplexus Neuropathy: This term describes the specific type of nerve damage that occurs in the lower back and pelvis, often associated with diabetic amyotrophy.
3. Diabetic Proximal Neuropathy: This term highlights the proximal muscle weakness that is a hallmark of the condition, affecting the muscles closest to the center of the body.
4. Diabetes-Related Muscle Weakness: A more general term that can encompass various forms of muscle weakness related to diabetes, including diabetic amyotrophy.

Related Terms

1. Type 2 Diabetes Mellitus (T2DM): The underlying condition that leads to diabetic amyotrophy, characterized by insulin resistance and relative insulin deficiency.
2. Neuropathy: A broad term for nerve damage, which can include various types of diabetic neuropathy, including peripheral and autonomic neuropathies.
3. Diabetic Neuropathy: A specific term for nerve damage caused by diabetes, which can manifest in various forms, including diabetic amyotrophy.
4. Muscle Atrophy: A general term for muscle wasting, which can occur in various conditions, including diabetes.
5. Diabetic Complications: This encompasses a range of health issues that can arise from diabetes, including neuropathy, retinopathy, nephropathy, and cardiovascular diseases.

Clinical Context

Diabetic amyotrophy is often underdiagnosed and can significantly impact the quality of life for individuals with Type 2 diabetes. It typically presents with sudden onset of weakness in the proximal muscles, often accompanied by pain. Understanding the terminology associated with E11.44 is crucial for accurate diagnosis, treatment planning, and coding for insurance purposes.

Conclusion

Familiarity with alternative names and related terms for ICD-10 code E11.44 can enhance communication among healthcare providers and improve patient care. It is essential for medical professionals to recognize these terms to ensure accurate documentation and effective management of patients with Type 2 diabetes mellitus and its complications.

The diagnosis of Type 2 diabetes mellitus with diabetic amyotrophy, represented by the ICD-10 code E11.44, involves specific clinical criteria and considerations. Below is a detailed overview of the diagnostic criteria and relevant information regarding this condition.

Understanding Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is a chronic condition characterized by insulin resistance and relative insulin deficiency, leading to elevated blood glucose levels. It is often associated with various complications, including neuropathy, which can manifest as diabetic amyotrophy.

What is Diabetic Amyotrophy?

Diabetic amyotrophy, also known as diabetic lumbosacral radiculoplexus neuropathy, is a form of diabetic neuropathy that primarily affects the proximal muscles of the lower limbs. It is characterized by:

• Weakness: Patients may experience significant weakness in the hip and thigh muscles.
• Pain: Often presents with severe pain in the lower back, hips, or thighs.
• Atrophy: Muscle wasting can occur due to disuse and nerve damage.

Diagnostic Criteria for E11.44

To diagnose Type 2 diabetes mellitus with diabetic amyotrophy (E11.44), healthcare providers typically follow these criteria:

1. Confirmed Diagnosis of Type 2 Diabetes Mellitus

• Blood Glucose Levels: Diagnosis of T2DM is confirmed through laboratory tests showing:
• Fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L)
• 2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test
• A1C level ≥ 6.5% (48 mmol/mol)
• Random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis[1][2].

2. Clinical Symptoms of Diabetic Amyotrophy

• Neurological Assessment: Patients typically present with:
• Sudden onset of pain in the lower back or thighs.
• Weakness in the proximal muscles, leading to difficulty in walking or climbing stairs.

• Muscle atrophy observed during physical examination.

• Electrophysiological Studies: Nerve conduction studies may show signs of neuropathy, including reduced conduction velocities or abnormal responses in the affected muscles[3].

3. Exclusion of Other Causes

• Differential Diagnosis: It is crucial to rule out other potential causes of neuropathy, such as:
• Vitamin deficiencies (e.g., B12 deficiency)
• Alcoholic neuropathy
• Other systemic diseases (e.g., autoimmune disorders) that could mimic diabetic amyotrophy[4].

4. Management and Monitoring

• Regular Monitoring: Patients diagnosed with E11.44 should be monitored for glycemic control and potential complications of diabetes.
• Multidisciplinary Approach: Management may involve endocrinologists, neurologists, and physical therapists to address both diabetes management and neurological symptoms[5].

Conclusion

The diagnosis of Type 2 diabetes mellitus with diabetic amyotrophy (ICD-10 code E11.44) requires a comprehensive approach that includes confirming the diabetes diagnosis, assessing neurological symptoms, and ruling out other potential causes of neuropathy. Early recognition and management are essential to mitigate complications and improve the quality of life for affected individuals. Regular follow-up and a multidisciplinary care approach are recommended to manage both diabetes and its complications effectively.

For further information on coding and billing related to diabetic conditions, resources such as the ICD-10-CM coding guidelines and specific articles on diabetes management can provide additional insights[6][7].

Type 2 diabetes mellitus with diabetic amyotrophy, classified under ICD-10 code E11.44, is a condition characterized by muscle weakness and pain due to nerve damage associated with diabetes. This complication primarily affects the proximal muscles, leading to difficulties in mobility and daily activities. Effective management of this condition involves a multifaceted approach that addresses both diabetes control and the specific symptoms of diabetic amyotrophy.

Standard Treatment Approaches

1. Glycemic Control

Maintaining optimal blood glucose levels is crucial in managing Type 2 diabetes and preventing further complications. Treatment options include:

• Medications:
• Metformin is often the first-line medication for Type 2 diabetes, helping to improve insulin sensitivity and lower blood sugar levels[1].
• Sulfonylureas and DPP-4 inhibitors may be added if glycemic control is inadequate with metformin alone[2].

• GLP-1 receptor agonists and SGLT2 inhibitors are also effective in managing blood sugar and may provide additional cardiovascular benefits[3].

• Insulin Therapy: In cases where oral medications are insufficient, insulin therapy may be necessary to achieve better glycemic control[4].

2. Management of Diabetic Amyotrophy

Addressing the symptoms of diabetic amyotrophy is essential for improving quality of life. Treatment strategies include:

• Physical Therapy: Engaging in a structured physical therapy program can help improve muscle strength and function. Therapists may design individualized exercise regimens that focus on strengthening proximal muscles and enhancing mobility[5].

• Pain Management: Neuropathic pain associated with diabetic amyotrophy can be debilitating. Treatment options include:

• Antidepressants (e.g., amitriptyline) and anticonvulsants (e.g., gabapentin) are commonly prescribed to alleviate nerve pain[6].
• Topical treatments such as capsaicin cream may also provide relief for some patients[7].

3. Lifestyle Modifications

Lifestyle changes play a significant role in managing diabetes and its complications:

• Dietary Changes: A balanced diet rich in whole grains, lean proteins, healthy fats, and plenty of fruits and vegetables can help manage blood sugar levels. Patients are often advised to work with a registered dietitian to create a personalized meal plan[8].

• Regular Exercise: Engaging in regular physical activity can improve insulin sensitivity and overall health. Patients should aim for at least 150 minutes of moderate-intensity aerobic activity per week, along with strength training exercises[9].

• Weight Management: Achieving and maintaining a healthy weight can significantly improve glycemic control and reduce the risk of complications associated with diabetes[10].

4. Regular Monitoring and Follow-Up

Continuous monitoring of blood glucose levels and regular follow-up appointments with healthcare providers are essential for managing diabetes effectively. This includes:

• Routine Blood Tests: Regular A1C tests help assess long-term glucose control, while routine checks for kidney function, cholesterol levels, and blood pressure are also important[11].

• Foot Care: Patients should be educated on proper foot care to prevent ulcers and infections, which are common complications of diabetes[12].

Conclusion

Managing Type 2 diabetes mellitus with diabetic amyotrophy requires a comprehensive approach that includes glycemic control, symptom management, lifestyle modifications, and regular monitoring. By addressing both the underlying diabetes and the specific complications associated with diabetic amyotrophy, patients can improve their quality of life and reduce the risk of further complications. Collaboration with healthcare professionals, including endocrinologists, physical therapists, and dietitians, is vital for effective management of this condition.