Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections into the Subacromial Space of the Shoulder

Abstract

Background: Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing<br />pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose<br />levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on<br />blood glucose levels in diabetic patients with shoulder pathology.<br />Methods: Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromial<br />corticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucose<br />and most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily to<br />confirm their fasting morning glucose level for 10 days post-injection.<br />Results: Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of <7% had an average rise<br />in blood glucose of 38 mg/dL compared to 98 mg/dL in the poorly controlled group after injection (P<0.001). Wellcontrolled<br />patients' glucose levels returned to near baseline levels around post-injection day 8, while poorly controlled<br />patients levels remained elevated. Similarly, insulin-dependent diabetic patients had an average increase in fasting<br />glucose level of 99 mg/dL versus 50 mg/dL in non-insulin-dependent diabetic patients (P<0.001).<br />Conclusion: After corticosteroid injection, patients with well-controlled diabetes experience smaller elevations and<br />faster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similar<br />findings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of blood<br />glucose elevation while maintaining therapeutic benefit.