Treatment-Induced Neuropathy of Diabetes: Focus on Autonomic Neuropathy

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.