Treatment Induced Neuropathy of Diabetes

Abstract

Treatment induced neuropathy of diabetes is a condition characterized by the acute development of painful small fiber neuropathy and autonomic dysfunction in the setting of rapid glycemic control. The prevalence is not known but was reported in 10% of cases studied in a specialized diabetic neuropathy tertiary referral center. Treatment induced neuropathy of diabetes is typically reported with the sudden decrease in the glycosylated hemoglobin A1C in individuals with a history of longstanding hyperglycemia. It is more common in individuals with type 1 diabetes, but has been reported with use of insulin, diet alone and with use of oral hypoglycemic medications. The onset of neuropathy is typically 2–8 weeks after a change in glucose control. Although the primary clinical phenotype is one of a length dependent, predominantly small fiber, neuropathic process, there is the frequent concordant development of autonomic dysfunction, retinopathy, and nephropathy. Treatment induced neuropathy of diabetes does not have any specific guidance on a treatment plan, supportive care is the recommended approach. It is possible that more gradual reduction in glucose control may prevent the development of treatment induced neuropathy, although prospective clinical trials to investigate this question have not been conducted.