Treatment-Induced Neuropathy of Diabetes: Clinical Insights from a Case Series and Systematic Review

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.