Hyperglycemia after repeated periocular dexamethasone injections in patients with diabetes.
OBJECTIVE
To assess the hyperglycemic effect of 3 consecutive daily periocular steroid injections in patients with diabetes.


METHODS
Retrospective observational study in a national eye center.


METHODS
Twenty-five hospitalized patients with type 2 diabetes who received a subconjunctival (n = 11) or a peribulbar injection (n = 14) with 4 mg dexamethasone disodium phosphate once a day for 3 consecutive days for ocular conditions.


METHODS
Baseline patient characteristics were recorded as well as serial blood glucose measurements and hypoglycemic interventions, both performed according to a written protocol.


METHODS
Serial blood glucose measurements and hypoglycemic interventions.


RESULTS
Each ocular injection with dexamethasone was followed around 6 hours later by an increase of blood glucose up to a median doubling from baseline (+100% increase) followed by falls until the next injection, toward a median 13% increase from baseline before the next ocular injection. Older age (P<0.05), duration of diabetes (P = 0.01), and microangiopathy or macroangiopathy (P = 0.01) were associated with higher blood glucose rises. Using a 14-mmol/l threshold for intervention, the probability of requiring additional hypoglycemic treatment during ocular steroid therapy in patients with HbA1c >7.5% and up to 7.5% was 100% and 60%, respectively.


CONCLUSIONS
Periocular injections with dexamethasone in patients with type 2 diabetes induce a marked hyperglycemic effect, similar to that observed during intravenous pulse methylprednisolone.
Feldman-Billard
Sylvie
S
Service de Médecine Interne, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France. s.feldman@quinze-vingts.fr
Du Pasquier-Fediaevsky
Laurence
L
Héron
Emmanuel
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D003228:Conjunctiva / Q000187:drug effects; D003907:Dexamethasone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005128:Eye Diseases / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced* / Q000188:drug therapy; D007267:Injections; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000187:drug effects; D019233:Retreatment; D012189:Retrospective Studies
D001786:Blood Glucose; D003907:Dexamethasone; D005938:Glucocorticoids; D006442:Glycated Hemoglobin; D007328:Insulin; C004180:dexamethasone 21-phosphate