title: Effect of local corticosteroid injection of the hand and wrist on blood glucose in patients with diabetes mellitus.
abstract: Locally administered corticosteroids are a common therapy in many hand and wrist disorders. Corticosteroids pose a theoretical risk to patients with diabetes mellitus by potentially raising blood glucose to hyperglycemic levels. Although oral corticosteroids are known to have an effect on blood glucose control, limited data exist on extra-articular administration. The purpose of this study was to examine the systemic impact of extra-articularly administered corticosteroids in the hand and wrist on serum glucose concentration in patients with diabetes mellitus.Twenty-three patients with diabetes mellitus received a 1-mL triamcinolone acetonide injection for de Quervain's tenosynovitis, trigger finger, flexor carpi ulnaris tendonitis, or carpal tunnel syndrome. Patients recorded their daily morning blood glucose levels for 1 week before injection and for 4 weeks after injection. Average blood glucose levels increased slightly from baseline after injection, reaching statistical significance 1, 5, and 6 days after injection, but were not clinically significant (average increase, 14.2, 9.7, and 32.7 mg/dL, respectively). Isolated increases more than 2 times the standard deviation of preinjection values occurred at least once in the majority of patients. The frequency of hyperglycemic episodes increased after injection, but the proportions of patients with at least 1 hyperglycemic episode before and after injection were not significantly different.These results suggest that local corticosteroid injections are a clinically safe treatment option for inflammatory processes of the hand and wrist in patients with diabetes mellitus. On average, patients experienced slight increases in blood glucose after receiving an injection. Most experienced isolated increases substantially beyond baseline and isolated hyperglycemic effects, but these did not pose an apparent clinical risk.
authors.affiliation: C.V. Starr Hand Surgery Center, New York, New York 10019, USA. cvstarr@gmail.com
authors.forename: Louis W
authors.initials: LW
authors.lastname: Catalano
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Glickel
authors.forename: O Alton
authors.initials: OA
authors.lastname: Barron
authors.forename: Richard
authors.initials: R
authors.lastname: Harrison
authors.forename: Astrid
authors.initials: A
authors.lastname: Marshall
authors.forename: Marissa
authors.initials: M
authors.lastname: Purcelli-Lafer
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D002349:Carpal Tunnel Syndrome / Q000188:drug therapy*; D053684:De Quervain Disease / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006225:Hand; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D052256:Tendinopathy / Q000188:drug therapy*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects; D052582:Trigger Finger Disorder / Q000188:drug therapy*; D014953:Wrist
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide