Key result
Rapid correction of chronic hyperglycemia is linked to treatment-induced neuropathy presenting as severe postural hypotension.
Why the study?
Treatment-induced neuropathy of diabetes is under-recognised compared to other complications, causes significant morbidity, and has limited treatment options once symptoms develop.
Case Report (n=1)
Treatment-induced neuropathy of diabetes is an under-recognised complication of rapid hyperglycaemia correction that can cause severe autonomic neuropathy and postural hypotension.
Treatment-induced neuropathy of diabetes (TIND) is characterised by the acute onset of peripheral and autonomic neuropathy following rapid correction of chronic hyperglycaemia. We present a case of TIND presenting with severe, treatment-resistant postural hypotension, with a quantitative sudomotor axon reflex test confirming autonomic small fibre neuropathy. This complication is under-recognised compared to early worsening of diabetic retinopathy or peripheral neuropathy but causes significant patient morbidity. Given the limited treatment options once symptoms develop, prevention is critical. Future research should aim to validate gradual HbA1c reduction as an effective preventative strategy and focus on developing targeted treatment options for TIND, especially its autonomic manifestations.
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Macisaac et al. (2026) conducted a case report in Treatment-induced neuropathy of diabetes (n=1). Rapid correction of chronic hyperglycaemia was evaluated on Autonomic small fibre neuropathy. Rapid correction of chronic hyperglycaemia resulted in treatment-induced neuropathy of diabetes, presenting as severe postural hypotension in 1 patient.
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