Treatment-induced neuropathy of diabetes (TIND) is a potentially preventable complication that may occur after rapid improvement in glycemic control, particularly in individuals with chronically elevated blood glucose levels. A literature review published in Diabetes Research and Clinical Practice evaluated the clinical presentation, precipitating factors, management approaches, and long-term outcomes associated with TIND across studies published between 1995 and 2025. 

The review included case reports, case series, and observational cohort studies involving patients who developed neuropathic symptoms following intensified diabetes treatment. Overall, 26 studies encompassing 181 patients with TIND were analyzed.

Findings

• Rapid reduction in glycated hemoglobin (HbA1c), frequently after insulin initiation or intensification, oral antihyperglycemic therapy, or lifestyle intervention, emerged as the most consistent precipitating factor.
• Symptoms developed between 1 week and 6 months after treatment intensification, with most cases occurring within 4-8 weeks.
• Clinical features included severe burning distal neuropathic pain, paresthesias, autonomic dysfunction, and occasional large-fiber involvement.
• Symptomatic management commonly included gabapentinoids, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and opioids.
• Most patients experienced gradual symptom improvement or resolution over months to 1 year, although persistent neuropathy was reported in a minority of cases.

TIND represents a distinct complication associated with rapid glycemic correction in diabetes management. The findings emphasize the importance of recognizing high-risk patients and considering gradual glycemic improvement strategies to reduce neuropathy risk.