Treatment-Induced Neuropathy of Diabetes: Clinical Insights from a Case Series and Systematic Review
6 affiliations
- 1Department of Clinical Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, No. 8 Victor Babeș Street, 400012 Cluj-Napoca, Romania
- 2IMOGEN Institute, Centre of Advanced Research Studies, 400347 Cluj-Napoca, Romania
- 3RoNeuro Institute, Centre for Neurological Research and Diagnostic, 400364 Cluj-Napoca, Romania
- 4NeuroBrain Clinic, Calea Dumbrăvii, nr 46A, 550324 Sibiu, Romania
- 5Department of Diabetes and Nutrition Diseases, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 2–4 Clinicilor Street, 400006 Cluj-Napoca, Romania
- 6Diabetes and Nutrition Diseases Center, Emergency Clinical County Hospital Cluj, 400006 Cluj-Napoca, Romania
Abstract
Background/Objectives: Treatment-induced neuropathy of diabetes (TIND) is an under-recognized iatrogenic neuropathy that follows a rapid fall in glycated hemoglobin (HbA1c). We aimed to systematically summarize the published cases of TIND and to compare them with two patients evaluated at our center. Methods: We evaluated two patients at our center and systematically reviewed PubMed, Scopus, Web of Science and Google Scholar, following PRISMA 2020, for primary clinical studies of TIND. Data were synthesized descriptively. Results: Both patients developed painful neuropathy with autonomic symptoms after HbA1c falls of 15.3 and 6.4 percentage points and improved substantially, but incompletely, over two years. Moreover, the review included 47 publications (219 patients) and painful neuropathy with autonomic dysfunction predominated. In case reports, the median HbA1c fall was 7.3 percentage points, and onset occurred within 8 weeks in 26 of 47 publications. Recovery was complete in 8 and partial in 21 of 32 case reports with documented outcomes. Follow-up data were missing for 136 of 219 patients. Conclusions: Published cases show a recurrent temporal association between TIND and rapid HbA1c reduction, but cannot establish causality or prognosis. TIND should be recognized early, and gradual, monitored glycemic correction may be reasonable in high-risk patients.
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BibTeX
@article{draghici2026treatmentinduced,
title = {{Treatment-Induced Neuropathy of Diabetes: Clinical Insights from a Case Series and Systematic Review}},
author = {Nicu Catalin Draghici and Ruxandra Mosorescu and Cornelia Bala and Dana Mihaela Ciobanu and Hanna Maria Dragoș and Cristina Tecar and Livia Livinț Popa and Dafin Fior Mureșanu},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218760},
url = {https://www.mdpi.com/2077-0383/15/21/8760},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Treatment-Induced Neuropathy of Diabetes: Clinical Insights from a Case Series and Systematic Review
AU - Nicu Catalin Draghici
AU - Ruxandra Mosorescu
AU - Cornelia Bala
AU - Dana Mihaela Ciobanu
AU - Hanna Maria Dragoș
AU - Cristina Tecar
AU - Livia Livinț Popa
AU - Dafin Fior Mureșanu
PY - 2026
DA - 2026/11/09
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218760
UR - https://www.mdpi.com/2077-0383/15/21/8760
AB - Background/Objectives: Treatment-induced neuropathy of diabetes (TIND) is an under-recognized iatrogenic neuropathy that follows a rapid fall in glycated hemoglobin (HbA1c). We aimed to systematically summarize the published cases of TIND and to compare them with two patients evaluated at our center. Methods: We evaluated two patients at our center and systematically reviewed PubMed, Scopus, Web of Science and Google Scholar, following PRISMA 2020, for primary clinical studies of TIND. Data were synthesized descriptively. Results: Both patients developed painful neuropathy with autonomic symptoms after HbA1c falls of 15.3 and 6.4 percentage points and improved substantially, but incompletely, over two years. Moreover, the review included 47 publications (219 patients) and painful neuropathy with autonomic dysfunction predominated. In case reports, the median HbA1c fall was 7.3 percentage points, and onset occurred within 8 weeks in 26 of 47 publications. Recovery was complete in 8 and partial in 21 of 32 case reports with documented outcomes. Follow-up data were missing for 136 of 219 patients. Conclusions: Published cases show a recurrent temporal association between TIND and rapid HbA1c reduction, but cannot establish causality or prognosis. TIND should be recognized early, and gradual, monitored glycemic correction may be reasonable in high-risk patients.
SN - 2077-0383
ER -