Review| Volume 226, 102668, July 2020

Treatment induced neuropathy of diabetes


      • TIND is an iatrogenic complication of aggressive glycemic control.
      • Changes in HbA1C of 1% or more per month increase the risk of TIND development.
      • Up to 10% of patients with diabetic neuropathy have symptoms due to TIND.
      • Clinical features of TIND include neuropathic pain and autonomic dysfunction.
      • Current treatments are supportive, and encourage stable glucose control.



      Treatment induced neuropathy of diabetes (TIND) is an iatrogenic painful sensory and autonomic neuropathy. Although the prevalence is not known, it is seen in up to 10% of tertiary cases referred for evaluation of diabetic neuropathy.


      TIND is associated with a decrease in the glycosylated hemoglobin A1C in individuals with longstanding hyperglycemia. TIND is more common in individuals with type 1 diabetes, but can occur in anyone with diabetes through the use of insulin, oral hypoglycemic medications or diet control. There is an acute or subacute onset of neuropathy that is linked to the change in glucose control. Although the primary clinical manifestation is neuropathic pain there is a concurrent development of autonomic dysfunction, retinopathy and nephropathy.


      TIND is more common than previously suspected. The number of cases reported over the past 10 years is much greater than historical literature predicted. Increased attention to target glucose control as a physician metric could suggest a possible explanation for the increased in TIND cases reported in recent years. At present, supportive care is the only recommended treatment. Future research is necessary to define the underlying mechanism, prevent development and to guide treatment recommendations.


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