JBJS Reviews Editor’s Choice–Steroid Injections in Patients with Diabetes
It is well known that parenterally administered steroids affect the metabolism of glucose and cause abnormal blood glucose levels in diabetic patients. For this reason, physicians are careful regarding the use of parenteral steroids in the presence of diabetes. However, one of the most common procedures in the outpatient setting, a local, intra-articular steroid injection, seems to be done without as much consideration or knowledge regarding the potential systemic effects of peripherally absorbed steroid. In the March 2016 issue of JBJS Reviews, Choudhry et al. address the question of potential abnormal blood glucose levels in diabetic patients who undergo intra-articular steroid injection.
The investigators performed a literature search of 4 different databases and identified 532 manuscripts. After applying inclusion criteria, 7 studies with a total of 72 patients were analyzed. The studies showed that a rise in blood glucose levels follows intra-articular steroid injection. Four of the 7 studies showed that this rise was substantial. Indeed, peak values as high as 500 mg/dL were reached. In most patients, hyperglycemia occurred within 24 to 72 hours after injection; however, peak increases in blood glucose levels did not occur immediately in all patients and in some cases took several days to occur.
Diabetes mellitus affects 9.3% of the general population of the United States, and nearly half of adults with diabetes also have osteoarthritis. Based on the data presented in this report, careful consideration should be given to administering intra-articular steroids to patients with diabetes. Indeed, current evidence suggests that diabetic patients should be advised to monitor their blood glucose levels following an intra-articular steroid injection. Patients with Type-1 diabetes should check their blood glucose levels 3 to 4 times a day for 7 days and should seek advice from a physician if levels exceed 360 mg/dL. Patients with Type-2 diabetes should check blood glucose levels at least twice a day for 7 days and should seek advice from a physician if levels exceed 540 mg/dL.
Intra-articular steroid injection is one of the most frequently performed outpatient procedures, and the data in this report shed important light on this process. This is a “must read” article.
Thomas Einhorn, Editor