Question 110 from the document is:
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**Scenario:**
A 61-year-old man with a 20-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 8 months, which worsens at night. His hemoglobin A1c levels have remained less than 7.0% for the last year but were between 9.0% and 10.0% before adding insulin therapy to metformin 1 year ago. His medical history includes coronary artery disease, non-proliferative diabetic retinopathy, hypertension, and hyperlipidemia. Medications are aspart insulin, glargine, aspirin, metoprolol, atorvastatin, and lisinopril. On physical examination, findings are compatible with distal symmetrical polyneuropathy.
**Question:**
Which of the following is the most appropriate management of this patient's neuropathy?
**Options:**
A) Physiotherapy
B) Tight blood sugar control
C) Amitriptyline
D) Vitamin B12 supplements
E) Gabapentin
**Correct Answer:**
C) Amitriptyline
**Explanation:**
The patient is presenting with symptoms of diabetic peripheral neuropathy (DPN), which is a common complication of long-standing diabetes. Tight glycemic control is important for overall diabetes management but does not reverse neuropathy once it has developed. Amitriptyline is a tricyclic antidepressant that is commonly used to manage the pain associated with diabetic neuropathy. Gabapentin, another option, can also be effective for neuropathic pain but was not included in the original list of options. Therefore, Amitriptyline is the best choice among the provided options.
This question is related to the specialty of **Endocrinology**.