Science News: GLP-1RA–Associated Diabetic Lumbosacral Radiculoplexus and Common Fibular Neuropathies A Case-Control Evaluation

Published January 08, 2026

Science News

Submitted by: Justin Aaron Willer MD, FAAN
Edited by: Rebecca O'Bryan, MD
Citation: Triplett JD, Pinto MV, Young NP, et al. GLP-1RA-Associated Diabetic Lumbosacral Radiculoplexus and Common Fibular Neuropathies: A Case-Control Evaluation. Neurology. 2025;105(3):e213916. doi:10.1212/WNL.0000000000213916

Summary: Diabetic lumbosacral radiculoplexus neuropathy (DLRPN) and common fibular neuropathy (CFN) are associated with weight loss. The authors examined whether GLP-1RA usage is linked to these neuropathies.

26 patients had 27 episodes of DLRPN. Median onset was 6 months after initiation of treatment. Average HbA1c reduction was 2.4%, and there was an average of 13.9% weight loss. Microvasculitis was present in 4 of 5 nerve biopsies.

77 patients with CFN had 82 episodes of CFN with mean duration of treatment with GLP-1 of 15 months and median reduction in HbA1c of 1.2% with an average of 15% weight loss. The deep fibular branches were more affected than the superficial fibular nerve branches. A CMAP reduction of more than 30% was noted in 58 cases, a reduction of more than 50% in 46 cases, and an absent response in 21 cases.

One patient with DLRPN had previously had gastric bypass surgery 5 years earlier without developing DLRPN prior to GLP-1 usage.

Six patients with CFN had previous or distant history of gastric bypass surgery without prior history of CFN.

Patients with DLRPN compared to CFN had greater HbA1c reduction (2.4% vs 1.2%). Non-arteritic ischemic optic neuropathy, macular edema and retinopathy was not observed in this cohort.

Compared to controls, patients receiving GLP-1 were 51% more likely to experience DLRPN and 305 more likely to experience CFN.

Patients had poor glycemic control and obesity but minimal prior microvascular complications.

DLRPN is noted to have overlapping features with treatment induced neuropathy (TIND). 

Comments: This study indicates a need for closer monitoring of weight shifts and HbA1c in patients on GLP-1 and if rapid drops are found then reducing the dose of the GLP-1 or switching to an alternate medication should be considered.

GLP-1RAs are proposed to contribute to the development of DLRPN through metabolic shifts and rapid HbA1c reduction while CFN appears to be more related to weight loss.

Consider DLRPN in patients with marked decrease in HbA1c and new onset pain and consider the presence of fibular neuropathy at the fibular head in patients with significant weight loss on GLP-1.

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