title: Effects of epidural steroid injections on blood glucose levels in patients with diabetes mellitus.
abstract: METHODS
  A prospective cohort study.
  
  
  OBJECTIVE
  To evaluate the effects of epidural steroid injections (ESIs) on blood glucose levels in patients with diabetes mellitus.
  
  
  BACKGROUND
  ESIs are commonly used in the treatment of multiple spinal disorders. Corticosteroid injections have been evaluated in the total joints and hand literature showing systemic effects to diabetics.
  
  
  METHODS
  Diabetic patients who were scheduled for an ESI were given an opportunity to enroll in our IRB-approved study. We collected the patient's most recent hemoglobin A(1c) (hA(1c)) and then asked them to track their blood glucose numbers at least twice per day for 2 weeks prior to and after their ESIs.
  
  
  RESULTS
  We noted a statistically significant increase in blood glucose levels in diabetic patients (n = 30) after ESI. The mean blood glucose level prior to ESI was 160.18 ± 47.46, and, after ESI, it was 286.13 ± 111.11. This represents an average 125.96 ± 100.97 increase in blood glucose levels after injection. Using a nonlinear mixed effect model, the estimated half-life of this increase was 1.06 days (95% CI 0.80, 1.58), meaning that the patients were back within their normal standard deviation mean glucose levels within 2 days of injection. There was no association between observed glucose level change and preinjection hA(1c) levels or age (Spearman = 0.0326 and -0.1091 separately), indicating that there is no correlation between preinjection hA(1c) levels and systemic response to ESI.
  
  
  CONCLUSIONS
  ESIs were noted to cause a significant increase in the blood glucose levels in diabetics. There was no correlation between preinjection diabetic control, represented by hA(1c) levels, and postinjection response. Diabetics who are candidates for ESI should be counseled that a blood glucose increase may be apparent post intervention, but effects should not last longer than approximately 2 days.
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN 37232, USA.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Even
authors.forename: Colin G
authors.initials: CG
authors.lastname: Crosby
authors.forename: Yanna
authors.initials: Y
authors.lastname: Song
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
mesh_terms: D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D001786:Blood Glucose / Q000032:analysis; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006442:Glycated Hemoglobin / Q000032:analysis / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced*; D007268:Injections, Epidural; D011446:Prospective Studies; D013130:Spinal Stenosis / Q000097:blood / Q000150:complications / Q000188:drug therapy*
chemical_list: D001623:Betamethasone; D001786:Blood Glucose; D005938:Glucocorticoids; D006442:Glycated Hemoglobin