SLR - November 2016 - Mark Goss
Blood Glucose Levels Following Intra-Articular Steroid Injections in Patients with Diabetes: A Systematic Review
Reference: Choudhry MN, Malik RA, Charalambous CP. Blood Glucose Levels Following Intra-Articular Steroid Injections in Patients with Diabetes: A Systematic Review. JBJS Rev. 2016 Mar; 4(3).
Scientific Literature Review
Reviewed By: Mark Goss, DPM
Residency Program: Regions Hospital/HealthPartners Institute for Education and Research
Podiatric Relevance: Locally injected steroids are useful to the podiatric surgeon due to their anti-inflammatory properties when utilized to treat foot and ankle pathologies. When administered parenterally, steroids have been shown to influence glucose metabolism, resulting in abnormal serum glucose levels in diabetic patients. Better understanding of these effects could potentially improve postinjection care plans and the side effects of these injections. The authors performed a systematic review of studies that examined the effects of intra-articular steroid injections on blood glucose levels in patients with diabetes.
Methods: Prospective and retrospective studies evaluating the effect of intra-articular steroid injection on blood sugar levels in diabetic patients were identified through searches in PubMed, EMBASE, AMED and CINAHL databases. Following critical analysis of each article, a qualitative summary of the literature was produced. Observed data included type and dose of steroid injected, injection timing, time and level of significant increase in blood glucose after injection, time to return to baseline glucose level and how “significant increase” in each study was defined.
Results: Seven prospective studies met inclusion criteria and were used for analysis. The analysis included a total of 72 patients, who were all reported to have well-controlled diabetes. All studies demonstrated increased blood glucose levels from baseline following intra-articular steroid injection, although this increase was not significant in one study. The authors report highly variable timing to peak increase of glucose levels and of timing to baseline glucose levels following intra-articular injection. Glucose levels were noted to peak anywhere from several hours to days after injection.
Conclusions: The authors concluded that the relevant literature demonstrates the need for patients with diabetes to regularly monitor blood glucose levels following intra-articular steroid injection due to the potential risk of hyperglycemia. The reviewed studies only enrolled patients with good glycemic control, yet peak glucose levels of up to 500 mg/dL were identified postinjection. Based on the results, the authors recommend that patients with diabetes regularly monitor blood glucose levels for up to seven days postinjection and seek medical attention if safe levels are exceeded. However, there was heterogeneity of the reviewed studies in terms of patient characteristics, joints injected, type and dose of steroid used, definition of significant postinjection hyperglycemia and timing of blood glucose measurements. It is therefore difficult to draw more specific conclusions regarding influence of those variables on the timing and severity of postinjection hyperglycemia. This review is helpful, as the findings demonstrate the risk of hyperglycemia that should be discussed with patients with diabetes who are considering intra-articular steroid injection.