title: Elevated Hemoglobin A1C Levels Correlate with Blood Glucose Elevation in Diabetic Patients following Local Corticosteroid Injection in the Hand: A Prospective Study.
abstract: BACKGROUND
  Diabetic patients develop hand conditions that are managed with local corticosteroid injections. Injections can result in a transient elevation in serum glucose in diabetic patients. Hemoglobin A1c is the accepted measure of long-term plasma glucose control in diabetics (levels ≥7 percent reflect poor blood glucose control). The purpose of this study was to assess the relationship between hemoglobin A1c levels and increased blood glucose levels after corticosteroid injections.
  
  
  METHODS
  Twenty-five diabetic patients were evaluated prospectively. One milliliter containing 10 mg of triamcinolone acetonide was used. The most recent hemoglobin A1c level and normal average blood glucose levels were obtained. Glucose levels were obtained from patient recall of their daily blood glucose self- monitoring on the day of the injection. Postinjection blood glucose levels were recorded until levels returned to preinjection baseline.
  
  
  RESULTS
  Twenty patients (80 percent) had elevation of their blood glucose level from baseline. No patient had elevated blood glucose levels after 5 days. Patients with hemoglobin A1c levels greater than or equal to 7 percent had a higher blood glucose elevation and maintained this for longer than those who had a lower hemoglobin A1c level. Patients in the higher hemoglobin A1c group also had a higher number of hyperglycemic events. There was a strong or moderate correlation between hemoglobin A1c and elevated blood glucose levels during days 1 to 4.
  
  
  CONCLUSIONS
  Patients with hemoglobin A1c levels greater than or equal to 7 percent have elevations in blood glucose that are higher and last longer than patients with lower levels. Hemoglobin A1c levels can be used to roughly predict the degree of blood glucose elevation after corticosteroid injections into the hands of diabetic patients.
authors.affiliation: Philadelphia, Pa. From the Rothman Institute of Orthopedics at Thomas Jefferson University Hospital.
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: Jake
authors.initials: J
authors.lastname: Schroeder
authors.forename: C Edward
authors.initials: CE
authors.lastname: Hoffler
authors.forename: Jonas L
authors.initials: JL
authors.lastname: Matzon
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Lutsky
authors.forename: Pedro K
authors.initials: PK
authors.lastname: Beredjiklian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002349:Carpal Tunnel Syndrome / Q000188:drug therapy / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006225:Hand; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D007267:Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D052256:Tendinopathy / Q000188:drug therapy / Q000209:etiology; D014222:Triamcinolone Acetonide / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D005938:Glucocorticoids; D006442:Glycated Hemoglobin; D014222:Triamcinolone Acetonide; C517652:hemoglobin A1c protein, human