Blood Glucose Levels After Local Musculoskeletal Steroid Injections in Patients With Diabetes Mellitus: A Clinical Review

Abstract

Context:Diabetes mellitus (DM) has become an epidemic in the United States and is associated with increased risk of multiple comorbidities, including painful musculoskeletal conditions. A common treatment for many of these painful musculoskeletal conditions is local soft tissue and intra-articular corticosteroid injection (CSI). These local injections have the potential to cause elevated blood glucose levels (BGLs) and cause complications in patients with DM. Therefore, it was the objective of this investigation to review the currently available evidence that directly addresses the effects of local CSIs used for painful musculoskeletal conditions on BGL in patients with DM.Evidence Acquisition:PubMed, Google Scholar, EMBASE, CINAHL, and Cochrane Review databases were searched with a combination of the terms corticosteroid, glucocorticoid, steroid, injection, musculoskeletal, and diabetes. Search limits included the English language. Bibliographic references from these articles were also examined to identify pertinent literature.Study Design:Clinical review.Level of Evidence:Level 3.Results:Ten studies that met the inclusion criteria were reviewed. All these studies showed significant but transient increases in postinjection BGL after a single local CSI in patients with DM. There were no adverse reactions or complications reported.Conclusion:Single, local soft tissue and intra-articular musculoskeletal CSIs are most likely safe in patients with well-controlled DM.

Clinical Guidelines in the Management of Frozen Shoulder: An Update!

“…Of-note, steroid injections carry a risk of a transient increase in blood glucose levels (BGLs) occurring within 1-5 days in diabetic patients [60]. However, the rise in BGLs returns to baseline within 24 h to 10 days, and the benefit of steroid injection in improving pain scores and function outweighs any transient increase in BGLs.…”

“…However, the rise in BGLs returns to baseline within 24 h to 10 days, and the benefit of steroid injection in improving pain scores and function outweighs any transient increase in BGLs. Nevertheless, steroid injections must be avoided in patients with uncontrolled Diabetes, especially if BGL is more than 250 mg% [60].…”

Effectiveness of intramuscular gluteal glucocorticoid injection versus intra-articular glucocorticoid injection in knee osteoarthritis: design of a multicenter randomized, 24 weeks comparative parallel-group trial

“…Patients who have had an IA injection in the knee during the previous 6 months will be excluded, since a prolonged treatment effect of 24 weeks after injection has been described [19]. Patients with diabetes mellitus on insulin therapy or with a poor glycemic control (as assessed by their GP) cannot participate, as they might be at risk of prolonged blood glucose level elevation after glucocorticoid injection [20,21]. Patients who have been referred to an orthopedic surgeon will also be excluded from participation considering that these patients could become candidates for total knee or hip arthroplasty during the follow-up period of the study.…”

Possible effects of agent orange and posttraumatic stress disorder on hyperglycemia in Korean veterans from the US-Vietnam war

“…Moreover, the American Academy of Orthopedic Surgeons, American College of Sports Medicine, American Diabetes Association and American Medical Society for Sports Medicine have not provided recommendations on steroid injections in patients with DM. [ 18 ]…”