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Effects of epidural steroid injections on blood glucose levels in patients with diabetes mellitus.
MedLine Citation:
PMID:  21540770     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Study Design: A prospective cohort study.Objective: To evaluate the effects of epidural steroid injections (ESI) on blood glucose levels in patients with diabetes mellitus.Summary of Background Data: Epidural steroid injections 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 A1c (hA1c) and then asked them to track their blood glucose numbers at least twice per day for two weeks prior to and after their ESI.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 injection 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 two days of injection. There was no association between observed glucose level change and pre-injection hA1c levels or age (Spearman = 0.0326 and -0.1091 separately) indicating there is no correlation between pre-injection hA1c levels and systemic response to ESI.Conclusion: Epidural steroid injections were noted to cause a significant increase in the blood glucose levels in diabetics. There was no correlation between pre injection diabetic control, represented by hA1c levels, and post injection 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 two days.
Authors:
Jesse L Even; Colin G Crosby; Yanna Song; Matthew J McGirt; Clinton J Devin
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-2
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Vanderbilt University Medical Center, 1215 21st avenue. South, MCe south Tower, Suite 4200, Nashville, TN 37232.
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