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Changes in Blood Glucose Levels after Corticosteroid Injection in the Hand and Wrist
Jeffrey Stepan, BS; Daniel A. London, BA; Ryan P. Calfee, MD, MSc; Martin I. Boyer, MD
Department of Orthopedic Surgery, Washington University, St. Louis School of Medicine, St. Louis, MO

Introduction: Corticosteroid injections are used to treat common hand and wrist conditions. Some clinicians are hesitant to administer corticosteroids to diabetic patients due to the perceived risk of a serious hyperglycemic event. The purpose of this study was to quantify diabetic patients' change in blood glucose levels after corticosteroid injection, and to assess risk factors predicting increases in blood glucose levels.

Materials and Methods: This prospective case-crossover study followed diabetic patients receiving corticosteroid injections for common hand and wrist conditions. Patients recorded their morning (fasting) blood glucose values for 14 days post-injection. Post-injection days 1-7 represented “case” data, days 8-9 represented the washout period, and days 10-14 determined baseline fasting values. We used a mixed model to compare baseline fasting glucose levels to those attained on post-injection days 1-7. Spearman's rho determined if HbA1c correlated with changes in blood glucose levels, and a linear regression model determined patient risk factors for increased post-injection blood glucose levels.

Results: Of 67 recruited patients, 40 provided full data. Patient demographics and baseline values are documented in Table 1. There was a significant increase in fasting blood glucose levels on post-injection day 1 (43.3mg/dl, 95%CI: 19.4-67.1) and post-injection day 2 (17.1mg/dl, 95%CI: 2.0-32.2), with a non-significant increase on day 3 (11.9mg/dl, 95%CI: -7.4-31.2). There was no significant increase on post-injection days 4-7 (Figure 1). 30 patients (75%) had available HbA1c data; HbA1c levels did not correlate with a rise in post-injection glucose levels (Spearman's rho 0.15, p=0.42). The linear regression model showed type 1 diabetes (ß=72.2, 95%CI: 5.7 to 139) and insulin use (ß=62.5, 95%CI: 8.7 to 116), after accounting for amount and location of injection, are predictive of increases in fasting blood glucose levels on post-injection day 1.

Conclusions: We found a significant rise in blood glucose levels 1-2 days post-injection with a subsequent return to baseline levels. Based on our data and previous literature, we now advise diabetic patients about the effect of corticosteroid injection on their blood glucose levels based on their diabetic type and treatment regimen, expecting greater increases in glucose in type I diabetics using insulin.

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