First case of insulin neuritis after islet transplantation
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Insulin neuritis, recently renamed “Treatment-induced neuropathy of diabetes” (TIND), is a rare iatrogenic complication first described in 1933 by Caravatti, and more recently characterized by Gibbons . It presents as an acute, painful, and autonomic neuropathy occurring within 8 weeks in patients with chronic hyperglycemia in whom rapid glycemic improvement is achieved by dietary restriction or hypoglycemic agents . Although known to dramatically improve glycemic control, pancreas or islet transplantation has never been reported to cause TIND.
We report the case of a 35-year-old female with a 23-year history of type 1 diabetes presenting with brittle diabetes despite sensor-augmented pump therapy. She had proliferative retinopathy with vitreous hemorrhage, treated by pan-retinal photocoagulation 5 years previously, and considered stable at the time of transplantation; microalbuminuria (190 mg/24 h) with normal renal function; painful distal neuropathy well controlled by...
KeywordsIslet transplantation Insulin neuritis Treatment-induced insulin neuropathy Diabetic autonomic neuropathy
The TRIMECO Trial is funded by the DGOS (Directorate of Health Care Provision); the National Programme for Hospital Research (PHRC 08PHR01); the National Agency for the Safety of Medicines and Health Products (ANSM) (TC266A). We would like to thank F. Ecarnot (EA3920, University Hospital Besancon, France) for editorial assistance.
LM and SB collected the data and wrote the manuscript. LM, AP, and SB followed the patient. TB contributed to the transplantation procedure. TB, AP, PYB, and SB participated to the TRIMECO Trial inclusion committee.
Compliance with ethical standards
Sophie Borot takes responsibility for the contents of this article.
Conflict of interest
No author has any financial disclosure or conflict of interest related to the content of this article.
Research involving Human participants
All procedures performed in the Trimeco study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
All human included in the Trimeco trial gave their inform consent prior to the inclusion in the study.