title: Blood Glucose Levels Following Intra-Articular Steroid Injections in Patients with Diabetes: A Systematic Review.
abstract: Parenterally administered steroids have been shown to affect the metabolism of glucose and to cause abnormal blood glucose levels in diabetic patients. These abnormal blood glucose levels in diabetic patients raise concerns that intra-articular steroid injections also may affect blood glucose levels. We performed a systematic review of studies examining the effect of intra-articular steroid injections on blood glucose levels in patients with diabetes mellitus.
  
  
  
  A literature search of the PubMed, EMBASE, AMED, and CINAHL databases using all relevant keywords and phrases revealed 532 manuscripts. After the application of inclusion criteria, seven studies with a total of seventy-two patients were analyzed.
  
  
  
  All studies showed a rise in blood glucose levels following intra-articular steroid injection. Four of the seven studies showed a substantial increase in blood glucose. Peak values reached as high as 500 mg/dL. The peak increase in blood glucose did not occur immediately following intra-articular steroid injection, and in some cases it took several days to occur. In many patients, post-injection hyperglycemia occurred within twenty-four to seventy-two hours.
  
  
  
  Intra-articular steroid injections may cause hyperglycemia in patients with diabetes mellitus, and patients should be warned of this complication. Diabetic patients should be advised to regularly monitor their blood glucose levels for up to a week after injection and should seek medical advice if safe thresholds are breached.
  
  
  
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors: Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, Lancashire, UK.
authors: M N
authors: MN
authors: Choudhry
authors: Weill Cornell Medical College, Doha, Qatar.
authors: R A
authors: RA
authors: Malik
authors: Department of Trauma and Orthopaedics, Blackpool Teaching Hospitals NHS Trust, Blackpool, Lancashire, UK.|School of Medicine and Dentistry, University of Central Lancashire, Preston, Lancashire, UK.|Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
authors: Charalambos Panayiotou
authors: CP
authors: Charalambous
mesh_terms: D000328:Adult; D000368:Aged; D001168:Arthritis / Q000188:drug therapy; D001786:Blood Glucose / Q000187:drug effects; D048909:Diabetes Complications; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced; D007270:Injections, Intra-Articular; D008875:Middle Aged; D013256:Steroids / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D013256:Steroids