Highlights
- •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.
Abstract
Background
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.
Evidence
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: March 23, 2020
Accepted:
March 22,
2020
Received in revised form:
January 31,
2020
Received:
September 13,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
