Gibbons Christopher H
Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Palmer 111, Boston, MA, 02215, USA.
Curr Diab Rep. 2017 Oct 24;17(12):127. doi: 10.1007/s11892-017-0960-6.
Treatment-induced neuropathy of diabetes (TIND) is an under-recognized iatrogenic painful sensory and autonomic neuropathy. This review highlights the clinical symptoms and signs, raises awareness of the cause, and provides education about prevention of TIND.
TIND may be triggered by a rapid decline in the blood glucose levels following the use of insulin, oral hypoglycemic medications, or even diet only to control diabetes. This may be seen in up to 10% of patients with diabetic neuropathy and has the potential for significant long-term complications that could be avoided through careful disease management. Based on the available evidence, a decrease in the glycosylated hemoglobin A1C of more than 3 points in 3 months in individuals with chronic hyperglycemia increases the risk of developing TIND. TIND is more common than previously suspected, and is tied to rates of glycemic control. Slower changes to glucose control are suggested, although there is no prospective data on disease prevention. Future research is necessary to guide treatment recommendations.
治疗所致糖尿病性神经病变（TIND）是一种未得到充分认识的医源性疼痛性感觉和自主神经病变。本综述着重介绍其临床症状和体征，提高对病因的认识，并提供有关TIND预防的知识。
TIND可能由使用胰岛素、口服降糖药甚至仅通过饮食控制糖尿病后血糖水平迅速下降引发。在高达10%的糖尿病神经病变患者中可见这种情况，且有可能导致严重的长期并发症，而通过谨慎的疾病管理这些并发症是可以避免的。根据现有证据，慢性高血糖个体在3个月内糖化血红蛋白A1C下降超过3个百分点会增加发生TIND的风险。TIND比之前怀疑的更为常见，且与血糖控制率相关。建议更缓慢地改变血糖控制，尽管尚无关于疾病预防的前瞻性数据。未来有必要开展研究以指导治疗建议。
