Evidence mapPaperPMID 20437589Full record

ArticleAnnals of neurology2010

Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy.

Christopher H Gibbons, Roy Freeman

Registry-linked trialOpen access · greenAbstract read
In one paragraph

Article in Annals of neurology, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02915263 (A Double-Blind, Randomized, Placebo-Controlled Trial To Evaluate The Efficacy Of Intravenous Immunoglobulin Therapy In Treatment Induced Neuropathy Of Diabetes), which is not on this map. Cited by 70 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
70citing papers in PubMed, 3 pooled it
3.0field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02915263 phase2terminatednot on this mapstarted 2017, after this paper: background citation

A Double-Blind, Randomized, Placebo-Controlled Trial To Evaluate The Efficacy Of Intravenous Immunoglobulin Therapy In Treatment Induced Neuropathy Of Diabetes

TypeinterventionalSponsorBeth Israel Deaconess Medical CenterRan2017 to 2022Enrolled13ConditionsDiabetes Complications, Diabetes Mellitus, Diabetic NeuropathiesArmsIGIV-C, 0.9% Sodium Chloride
3 · Its place in the literature

Who cites it

70 citing papers in PubMed, 3 syntheses or guidelines pooled it, 207 citations in OpenAlex.

  1. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2022
    Guideline
  2. Physical activity and dietary interventions in diabetic neuropathy: a systematic review.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2019
    Pooled it
  3. Neuromuscular complications of diabetes mellitus.Continuum (Minneapolis, Minn.) · 2014
    Pooled it
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  9. Treatment-induced neuropathy of diabetes complicated by orthostatic hypotension.Endocrinology, diabetes & metabolism case reports · 2025
    Article
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10 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors at 1 institution in 1 country.

Christopher H GibbonsDepartment of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Roy Freeman
Beth Israel Deaconess Medical Center · US

Funding

HYPOGLYCEMIA AND AUTONOMIC NERVOUS SYSTEM FUNCTIONR01DK063296 · BETH ISRAEL DEACONESS MEDICAL CENTER · 2003 to 2005
$1.8M
NIDDK NIH HHS R01DK063296NINDS NIH HHS K23 NS050209NINDS NIH HHS K23NS050209
6 · The paper itself

Abstract

objectiveTo describe the natural history, clinical, neurophysiological, and histological features, and outcomes of diabetic patients presenting with acute painful neuropathy associated with glycemic control, also referred to as insulin neuritis.

methodsSixteen subjects presenting with acute painful neuropathy had neurological and retinal examinations, laboratory studies, autonomic testing, and pain assessments over 18 months. Eight subjects had skin biopsies for evaluation of intraepidermal nerve fiber density.

resultsAll subjects developed severe pain within 8 weeks of intensive glucose control. There was a high prevalence of autonomic cardiovascular, gastrointestinal, genitourinary, and sudomotor symptoms in all subjects. Orthostatic hypotension and parasympathetic dysfunction were seen in 69% of subjects. Retinopathy worsened in all subjects. Reduced intraepidermal nerve fiber density (IENFD) was seen in all tested subjects. After 18 months of glycemic control, there were substantial improvements in pain, autonomic symptoms, autonomic test results, and IENFD. Greater improvements were seen after 18 months in type 1 versus type 2 diabetic subjects in autonomic symptoms (cardiovascular p < 0.01; gastrointestinal p < 0.01; genitourinary p < 0.01) and autonomic function tests (p < 0.01, sympathetic and parasympathetic function tests).

interpretationTreatment-induced neuropathy is characterized by acute, severe pain, peripheral nerve degeneration, and autonomic dysfunction after intensive glycemic control. The neuropathy occurred in parallel with worsening diabetic retinopathy, suggesting a common underlying pathophysiological mechanism. Clinical features and objective measures of small myelinated and unmyelinated nerve fibers can improve in these diabetic patients despite a prolonged history of poor glucose control, with greater improvement seen in patients with type 1 diabetes.

Indexed as

AdultAutonomic Nervous SystemBlood PressureDiabetic NeuropathiesFemaleHeart RateHumansLongitudinal StudiesMaleMiddle AgedNerve FibersNeuralgiaPain MeasurementSurveys and QuestionnairesValsalva Maneuver

Identifiers

PMID20437589
PMCPMC3057039
OpenAlexW2029209464

What Socratic holds

Textmetadata
LicenceTDM
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.