The effect of rapid improvement of blood glucose level on diabetic neuropathy in Korean people with diabetes mellitus.

AIMS: Treatment-induced neuropathy of diabetes is a well-documented complication of rapid glycemic improvement, yet its frequency and severity in guideline-concordant clinical settings remain uncertain.

METHODS

This prospective observational study assessed short-term changes in neuropathy and autonomic function in two Korean cohorts undergoing rapid glycemic control: the Boramae Neuropathy cohort (n = 71, ≥2% HbA1c reduction over 12 weeks) and the TRIPLE-AXEL cohort (n = 79 newly diagnosed, drug-naïve type 2 diabetes patients with ≥ 2% HbA1c reduction). Measures included Neuropathy Total Symptom Score-6 (NTSS-6), Michigan Neuropathy Screening Instrument (MNSI), and Composite Autonomic Symptom Score-31 (COMPASS-31).

RESULTS

Despite marked HbA1c reductions, neuropathy indices did not worsen. In the Boramae cohort, HbA1c decreased from 11.3 ± 1.4% to 6.9 ± 0.8%, NTSS-6 remained stable, and abnormal COMPASS-31 prevalence fell from 36.6% to 29.6%. In TRIPLE-AXEL, HbA1c decreased from 9.5 ± 0.8% to 6.4 ± 0.6%, with no increases in MNSI or COMPASS-31 scores and reduced abnormal COMPASS-31 prevalence (6.3% to 1.3%). A small subset in the Boramae cohort (8.5%) developed abnormal COMPASS-31 scores, mainly orthostatic symptoms, without increased neuropathic pain.

CONCLUSION

Rapid glycemic improvement was not associated with clinically meaningful short-term worsening of neuropathy. Mild, domain-specific autonomic changes occurred in a minority without painful neuropathy, supporting the safety of intensive glycemic control with appropriate screening.