Jeffrey G Stepan1, Daniel A London2, Martin I Boyer2, Ryan P Calfee2. 1. Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO; Washington University School of Medicine in St. Louis, St. Louis, MO; Washington University in St. Louis Institute of Clinical and Translational Sciences, St. Louis, MO. Electronic address: stepanj@wusm.wustl.edu. 2. Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO; Washington University School of Medicine in St. Louis, St. Louis, MO; Washington University in St. Louis Institute of Clinical and Translational Sciences, St. Louis, MO.
Abstract
PURPOSE: To quantify diabetic patients' change in blood glucose levels after corticosteroid injection for common hand diseases and to assess which patient-level risk factors may predict an increase in blood glucose levels. METHODS: Patients were recruited for this case-crossover study in the clinic of fellowship-trained hand surgeons at a tertiary care center. Patients with diabetes mellitus type 1 or 2, who received a corticosteroid injection, recorded the morning fasting blood glucose levels for 14 days after the injection. Fasting glucose levels on days 1 to 7 after injection qualified as case data; levels on days 10 to 14 provided control data. A mixed model with a priori contrasts was used to compare postinjection blood glucose levels with baseline levels. We used a linear regression model to determine patient predictors of a postinjection rise in blood glucose levels. RESULTS: Of 67 patients recruited for the study returned, 40 (60%) completed blood glucose logs. There was a significant increase in fasting blood glucose levels after injection limited to postinjection days 1 and 2. Among patient risk factors in the linear regression model, type 1 diabetes and use of insulin each predicted a postinjection increase in blood glucose levels from baseline, whereas higher glycated hemoglobin levels did not predict increases. CONCLUSIONS: Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. Patients with type 1 diabetes and insulin-dependent diabetics are more likely to experience this transient rise in blood glucose levels. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
PURPOSE: To quantify diabeticpatients' change in blood glucose levels after corticosteroid injection for common hand diseases and to assess which patient-level risk factors may predict an increase in blood glucose levels. METHODS:Patients were recruited for this case-crossover study in the clinic of fellowship-trained hand surgeons at a tertiary care center. Patients with diabetes mellitus type 1 or 2, who received a corticosteroid injection, recorded the morning fasting blood glucose levels for 14 days after the injection. Fasting glucose levels on days 1 to 7 after injection qualified as case data; levels on days 10 to 14 provided control data. A mixed model with a priori contrasts was used to compare postinjection blood glucose levels with baseline levels. We used a linear regression model to determine patient predictors of a postinjection rise in blood glucose levels. RESULTS: Of 67 patients recruited for the study returned, 40 (60%) completed blood glucose logs. There was a significant increase in fasting blood glucose levels after injection limited to postinjection days 1 and 2. Among patient risk factors in the linear regression model, type 1 diabetes and use of insulin each predicted a postinjection increase in blood glucose levels from baseline, whereas higher glycated hemoglobin levels did not predict increases. CONCLUSIONS: Corticosteroid injections in the hand transiently increase blood glucose levels in diabeticpatients. Patients with type 1 diabetes and insulin-dependent diabetics are more likely to experience this transient rise in blood glucose levels. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
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