Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Palmer 111, Boston, MA 02215, United States of America.
Auton Neurosci. 2020 Jul;226:102668. doi: 10.1016/j.autneu.2020.102668. Epub 2020 Mar 23.
Treatment induced neuropathy of diabetes (TIND) is an iatrogenic painful sensory and autonomic neuropathy. Although the prevalence is not known, it is seen in up to 10% of tertiary cases referred for evaluation of diabetic neuropathy.
TIND is associated with a decrease in the glycosylated hemoglobin A1C in individuals with longstanding hyperglycemia. TIND is more common in individuals with type 1 diabetes, but can occur in anyone with diabetes through the use of insulin, oral hypoglycemic medications or diet control. There is an acute or subacute onset of neuropathy that is linked to the change in glucose control. Although the primary clinical manifestation is neuropathic pain there is a concurrent development of autonomic dysfunction, retinopathy and nephropathy.
TIND is more common than previously suspected. The number of cases reported over the past 10 years is much greater than historical literature predicted. Increased attention to target glucose control as a physician metric could suggest a possible explanation for the increased in TIND cases reported in recent years. At present, supportive care is the only recommended treatment. Future research is necessary to define the underlying mechanism, prevent development and to guide treatment recommendations.
糖尿病治疗相关神经病变（TIND）是一种医源性的痛性感觉和自主神经病变。尽管其患病率尚不清楚，但在因糖尿病神经病变而接受评估的三级病例中，高达 10%的患者存在 TIND。
TIND 与长期高血糖个体中糖化血红蛋白 A1C 的降低有关。TIND 在 1 型糖尿病患者中更为常见，但通过使用胰岛素、口服降糖药物或饮食控制，任何类型的糖尿病患者均可发生 TIND。TIND 的发病呈急性或亚急性，与血糖控制的变化有关。尽管主要的临床表现是神经性疼痛，但同时也会出现自主神经功能障碍、视网膜病变和肾病。
TIND 比以前怀疑的更为常见。过去 10 年报告的病例数远远超过了历史文献的预测。医生越来越关注目标血糖控制作为一种指标，这可能是近年来报告的 TIND 病例增加的一个可能解释。目前，仅推荐支持性治疗。需要进一步的研究来确定其潜在机制、预防发展并指导治疗建议。
