Treatment-induced neuropathy of diabetes: A comprehensive literature review

Treatment-induced neuropathy of diabetes (TIND) is an iatrogenic complication associated with rapid improvement in glycaemic control, often in individuals with chronically elevated blood glucose. It is characterised by acute neuropathic pain and autonomic dysfunction.

A literature review was conducted, including case reports, case series, and observational cohort studies published between 1995 and 2025. Data on clinical presentation, triggering factors, diagnostic features, management, and outcomes were extracted and synthesised.

A total of 26 studies were included, encompassing 181 patients with TIND. Rapid reduction in HbA_1c, often following insulin initiation or intensification, oral antihyperglycaemic therapy, or lifestyle interventions, was the most consistent precipitating factor. Symptoms typically appeared within 1 week to 6 months after treatment intensification, with the majority manifesting within 4-8 weeks. Clinical features included severe distal neuropathic pain of burning nature, paraesthesias, and autonomic dysfunction, with occasional large-fibre involvement. Management was largely symptomatic, with gabapentinoids, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), or opioids. Gradual improvement or resolution of symptoms occurred in most cases over months to one year, although persistent neuropathy was also reported in a minority of patients.

TIND is a distinct, potentially preventable complication of diabetes management. Recognition of high-risk patients and cautious, gradual improvement of glycaemic control are critical for prevention. Management remains largely symptomatic, and long-term outcomes vary depending on the speed of glycaemic correction and on baseline patient factors.