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Abstract Details

Treatment Induced Neuropathy of Diabetes
Peripheral Nerve
S58 - (-)
001
Treatment induced neuropathy of diabetes (TIND), previously called insulin neuritis, was first reported in 1933. We recently described 16 patients with treatment induced neuropathy of diabetes with autonomic dysfunction, neuropathic pain, small nerve fiber degeneration, and worsening nephropathy and retinopathy.
We studied 96 individuals with TIND (71 with type 1 diabetes and 25 with type 2 diabetes), monitored their graded neurological examination, symptoms, retinal examination, and chemistry, hematology and glycosylated hemoglobin (A1C) test results. Selected patients had autonomic function testing (heart rate variability to paced breathing, Valsalva maneuver and tilt table test) and intra-epidermal nerve fiber density (IENFD) by skin biopsy.
The mean A1C prior to glycemic control and onset of symptoms was 14.6卤4.3% and decreased to 7.5卤1.9% over 2.2卤1.1 months. Subjects developed severe distal (77%) or diffuse (23%) neuropathic pain (pain scores 4-10/10). Skin biopsies revealed normal intra-epidermal nerve fiber densities (IENFD) with numerous morphologic changes during the initial 3 weeks of pain that followed by subsequent denervation. Autonomic dysfunction was seen in 84%, severe autonomic dysfunction in 5% and worsening of retinopathy in 92%. Risk of TIND increased with a drop in A1C of more 3.5%, with a rate of A1C drop >2% per month and a final A1C <10%. There was a logarithmic increase in severity of TIND with greater falls in A1C per month.
Treatment induced neuropathy of diabetes is an underestimated iatrogenic disorder. Rapid glycemic change in patients with uncontrolled diabetes increases the risk of this complication. Further study is required to define the underlying mechanisms, natural history and appropriate therapy of this disorder.
Authors/Disclosures
Christopher H. Gibbons, MD, FAAN (Beth Israel Deaconess Medical Center)
PRESENTER 		Dr. Gibbons has received personal compensation for serving as an employee of CND Life Sciences. Dr. Gibbons has or had stock in CND Life Sciences.Dr. Gibbons has received publishing royalties from a publication relating to health care.
Roy L. Freeman, MD (Beth Israel Deaconess Hosp) Dr. Freeman has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Cutaneous Diagnostic Life Sciences. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vertex. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Theravance. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Inhibikase. Dr. Freeman has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Freeman has received research support from NIH. The institution of Dr. Freeman has received research support from Theravance. The institution of Dr. Freeman has received research support from Biohaven. The institution of Dr. Freeman has received research support from Lundbeck. Dr. Freeman has received research support from Regeneron.
Orla Hardiman, MD, DSc, FRCPI, MRIA, FAAN (Trinity Biomedical Sciences Institute) Dr. Hardiman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Wave Pharmaceuticals. Dr. Hardiman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cytokinetics . Dr. Hardiman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Hardiman has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Taylor and Francis. The institution of Dr. Hardiman has received research support from Science Foundation Ireland. The institution of Dr. Hardiman has received research support from HRB.