Purpose of Review
Treatment-induced neuropathy of diabetes (TIND) is an under-recognized iatrogenic painful sensory and autonomic neuropathy. This review highlights the clinical symptoms and signs, raises awareness of the cause, and provides education about prevention of TIND.
TIND may be triggered by a rapid decline in the blood glucose levels following the use of insulin, oral hypoglycemic medications, or even diet only to control diabetes. This may be seen in up to 10% of patients with diabetic neuropathy and has the potential for significant long-term complications that could be avoided through careful disease management. Based on the available evidence, a decrease in the glycosylated hemoglobin A1C of more than 3 points in 3 months in individuals with chronic hyperglycemia increases the risk of developing TIND.
TIND is more common than previously suspected, and is tied to rates of glycemic control. Slower changes to glucose control are suggested, although there is no prospective data on disease prevention. Future research is necessary to guide treatment recommendations.
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Conflict of Interest
Christopher H. Gibbons has received research funding from Celgene and Grifols, and has served on advisory boards for Lundbeck and Pfizer, and served on data safety monitoring boards of Janssen and Astellas.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Microvascular Complications—Neuropathy
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Gibbons, C.H. Treatment-Induced Neuropathy of Diabetes. Curr Diab Rep 17, 127 (2017). https://doi.org/10.1007/s11892-017-0960-6