M N Choudhry1, R A Malik, Charalambos Panayiotou Charalambous. 1. 1Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, Lancashire, UK 2Weill Cornell Medical College, Doha, Qatar 3Department of Trauma and Orthopaedics, Blackpool Teaching Hospitals NHS Trust, Blackpool, Lancashire, UK 4School of Medicine and Dentistry, University of Central Lancashire, Preston, Lancashire, UK 5Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
Abstract
BACKGROUND: Parenterally administered steroids have been shown to affect the metabolism of glucose and to cause abnormal blood glucose levels in diabetic patients. These abnormal blood glucose levels in diabetic patients raise concerns that intra-articular steroid injections also may affect blood glucose levels. We performed a systematic review of studies examining the effect of intra-articular steroid injections on blood glucose levels in patients with diabetes mellitus. METHODS: A literature search of the PubMed, EMBASE, AMED, and CINAHL databases using all relevant keywords and phrases revealed 532 manuscripts. After the application of inclusion criteria, seven studies with a total of seventy-two patients were analyzed. RESULTS: All studies showed a rise in blood glucose levels following intra-articular steroid injection. Four of the seven studies showed a substantial increase in blood glucose. Peak values reached as high as 500 mg/dL. The peak increase in blood glucose did not occur immediately following intra-articular steroid injection, and in some cases it took several days to occur. In many patients, post-injection hyperglycemia occurred within twenty-four to seventy-two hours. CONCLUSION: Intra-articular steroid injections may cause hyperglycemia in patients with diabetes mellitus, and patients should be warned of this complication. Diabetic patients should be advised to regularly monitor their blood glucose levels for up to a week after injection and should seek medical advice if safe thresholds are breached. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND: Parenterally administered steroids have been shown to affect the metabolism of glucose and to cause abnormal blood glucose levels in diabeticpatients. These abnormal blood glucose levels in diabeticpatients raise concerns that intra-articularsteroid injections also may affect blood glucose levels. We performed a systematic review of studies examining the effect of intra-articularsteroid injections on blood glucose levels in patients with diabetes mellitus. METHODS: A literature search of the PubMed, EMBASE, AMED, and CINAHL databases using all relevant keywords and phrases revealed 532 manuscripts. After the application of inclusion criteria, seven studies with a total of seventy-two patients were analyzed. RESULTS: All studies showed a rise in blood glucose levels following intra-articularsteroid injection. Four of the seven studies showed a substantial increase in blood glucose. Peak values reached as high as 500 mg/dL. The peak increase in blood glucose did not occur immediately following intra-articularsteroid injection, and in some cases it took several days to occur. In many patients, post-injection hyperglycemia occurred within twenty-four to seventy-two hours. CONCLUSION:Intra-articularsteroid injections may cause hyperglycemia in patients with diabetes mellitus, and patients should be warned of this complication. Diabeticpatients should be advised to regularly monitor their blood glucose levels for up to a week after injection and should seek medical advice if safe thresholds are breached. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Authors: Nicola Veronese; Cyrus Cooper; Jean-Yves Reginster; Marc Hochberg; Jaime Branco; Olivier Bruyère; Roland Chapurlat; Nasser Al-Daghri; Elaine Dennison; Gabriel Herrero-Beaumont; Jean-François Kaux; Emmanuel Maheu; René Rizzoli; Roland Roth; Lucio C Rovati; Daniel Uebelhart; Mila Vlaskovska; André Scheen Journal: Semin Arthritis Rheum Date: 2019-01-11 Impact factor: 5.532
Authors: Cyrus Cooper; François Rannou; Pascal Richette; Olivier Bruyère; Nasser Al-Daghri; Roy D Altman; Maria Luisa Brandi; Sabine Collaud Basset; Gabriel Herrero-Beaumont; Alberto Migliore; Karel Pavelka; Daniel Uebelhart; Jean-Yves Reginster Journal: Arthritis Care Res (Hoboken) Date: 2017-08-08 Impact factor: 4.794