Clinical Question

What are the change in and duration of hyperglycemia after intra-articular steroid injections in patients with diabetes mellitus?

Evidence-Based Answer

In patients with well-controlled type 2 diabetes, blood glucose levels may reach peak values of 165 to 500 mg per dL (9.16 to 27.75 mmol per L) at 2 to 84 hours after intra-articular steroid injections and return to baseline in 18 hours to 21 days. Patients with type 2 diabetes receiving injections of extended-release triamcinolone had no significant increase in blood glucose compared with a 23% increase in patients receiving crystalline suspension triamcinolone. Patients with type 2 diabetes showed a statistically significant, but s clinically questionable, increase in fructosamine levels of 4.1% above baseline, measured two to three weeks after intra-articular knee injections. Patients with poorly controlled diabetes should be informed of the potential risk of transient hyperglycemia following an intra-articular steroid injection and should closely monitor glucose levels, particularly on days 1 to 3 postinjection. (Strength of Recommendation: C, consensus opinion, disease-oriented evidence.)