Chapter 12 - Treatment-induced painful diabetic neuropathy

Abstract

Treatment-induced neuropathy of diabetes (TIND) is a form of painful sensory and autonomic diabetic neuropathy that manifests after rapid improvement of glycemic control in individuals with previously inadequately controlled diabetes. This form of diabetic neuropathy can occur in any type of diabetes treated with insulin, injectable GLP-1 agonists, oral antidiabetic drugs, or even diet control. Acute or subacute neuropathic pain occurs secondary to the change in glucose control and is frequently accompanied by autonomic dysfunction. Moreover, an increased risk of deterioration of retinopathy or nephropathy has been reported. Although the prevalence of TIND is unknown, it is probably also underreported. It differs from typical diabetic neuropathy by its reversibility, at least in patients who later have stable glycemic control. In addition to glycemic control, supportive care and neuropathic pain treatment are the only treatments available for TIND. Neuropathic pain is ultimately resolved in most patients, but often only after 1–2 years. Future research is needed to characterize the natural history and underlying mechanisms of TIND and to prevent this neuropathy and provide treatment recommendations for it.