Treatment induced neuropathy of diabetes-Long term implications in type 1 diabetes.
OBJECTIVE
Aggressive glucose control can result in treatment induced neuropathy of diabetes (TIND) if glycemic control is achieved too quickly. The aim of the present study is to describe the 8-year follow-up data on a cohort of individuals with type 1 diabetes who developed TIND.


METHODS
Twenty-six individuals with type 1 diabetes and TIND were followed longitudinally for 8years with regular quantitative measurement of pain, neurological examinations and evaluation of microvascular complications. Comprehensive neurological testing was performed after TIND and 7-8years later.


RESULTS
Among the 26 individuals with TIND, 19/26 had stable glycemic control and 7/26 had unstable glycemic control in long-term follow up. Those 19/26 with stable glycemic control had improvement in neuropathy, pain and microvascular complications while the 7/26 with unstable glycemic control had significant worsening of neuropathy, pain and microvascular complications (P<0.01, all tests).


CONCLUSIONS
TIND is a poorly understood iatrogenic complication of aggressive glycemic control, although individuals with stable glycemic control tended to improve, while those with unstable glycemic control worsened. Additional studies of TIND are required to understand potential outcomes in an era of medical 'metrics' where physician reimbursement may be tied to achievement of excessively rapid glycemic control.
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Electronic address: cgibbons@bidmc.harvard.edu.
Christopher H
CH
Gibbons
D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001342:Autonomic Nervous System Diseases / Q000150:complications / Q000209:etiology* / Q000503:physiopathology; D001900:Boston; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000209:etiology / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006782:Hospitals, Special; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D035002:Lower Extremity; D008297:Male; D055806:Microvessels / Q000294:innervation / Q000503:physiopathology; D010146:Pain / Q000150:complications / Q000209:etiology* / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000209:etiology* / Q000503:physiopathology; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
Autonomic; Microvascular; Nephropathy; Neuropathy; Pain; Retinopathy