title: The effect of intra-articular triamcinolone preparations on blood glucose levels in diabetic patients: a controlled study.
abstract: OBJECTIVE
  The objective of the study was to evaluate the effect of intra-articular (IA) triamcinolone hexacetonide (TAH) and triamcinolone acetonide (TA) on blood glucose levels in patients with controlled diabetes with symptomatic osteoarthritis of the knee (OAK).
  
  
  METHODS
  Patients with controlled diabetes with symptomatic OAK who failed nonsteroidal anti-inflammatory medication and physical therapy and use modern versions of self-monitoring blood glucose devices were offered an IA injection of either 20 mg of TAH or 40 mg of TA. If agreed, patients were asked to document blood glucose levels before and 2 hr after meals for 1 week before and daily for 5 days then every other day for 1 week following the injection. The type of IA preparation was given on an alternating pattern. A sex- and aged-matched group of patients with controlled diabetes with symptomatic OAK of the knee was offered an IA hyaluronic acid (HA) injection. Significantly increased blood glucose level following the IA injection was defined as higher by at least 2 SDs than the mean comparable level before the injection.
  
  
  RESULTS
  Thirty patients completed the study: 12 patients in the TAH, 12 patients in the TA group, and 6 in the HA group. All the patients who received triamcinolone preparations had significantly increased blood glucose levels with median initial levels of 227.5 and 201 mg% seen at a median of 8.5 and 13 hr following the IA injection and median peak levels of 288 and 239.5 mg% seen after a median of 24.5 and 32.5 hr following the IA injection of TA and TAH, respectively. Levels returned to normal after ∼2.5 to ∼4 days. There was no significant increase in the HA group except in 1 measurement only with marginal level in 2 patients.
  
  
  CONCLUSIONS
  Intra-articular injection of either TAH or TA is associated with significantly increased blood glucose levels in patients with controlled diabetes with OAK. This increase is quite solely due to the injected steroids.
authors.affiliation: Rheumatology Clinic, Nazareth Hospital, Nazareth, Israel. gshabib62@yahoo.com
authors.forename: George S
authors.initials: GS
authors.lastname: Habib
authors.forename: Walid
authors.initials: W
authors.lastname: Miari
mesh_terms: D000276:Adjuvants, Immunologic / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000494:pharmacology / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D014222:Triamcinolone Acetonide / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000276:Adjuvants, Immunologic; D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D014221:Triamcinolone; D006820:Hyaluronic Acid; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide