The American Academy of Pain Medicine      Annual Meeting Home Page     
24th Annual Meeting
February 13-16, 2008
Orlando, FL

2006 American Academy of Pain Medicine
 


Thursday, February 14, 2008
184

Changes in Blood Glucose Levels in Diabetics After Epidural Steroid Injection

Andrew Linn, M.D., Adam Stoller, M.D., Thomas Simopoulos, M.D., and Christine Peeters-Asdourian, M.D. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Introduction

The use of epidural steroids is a widely accepted treatment for certain types of chronic pain. A depot formulation of steroid is administered because of its extremely limited solubility in aqueous solutions, theoretically limiting systemic absorption and prolonging the target-site effect. However,the systemic glycemic effect of epidurally administered glucocorticosteroids(GCS) on diabetics is unknown.

Methods

The day of and prior to receiving epidural steroid injection, hemoglobin A1c levels were drawn. Patients were given a glucose log and asked to write down morning fasting blood glucose levels. If an insulin sliding scale was used, daily totals of insulin use were recorded. Any changes in medications during the study period were noted. Participation in the study was 14 days prior to and 14 days after epidural steroid injection. Baseline levels 14 days prior to epidural injection were determined from blood glucose logs, or from data stored in glucometer memory.

Statistical analysis consisting of paired t-tests, Pearson's correlation coefficient, was performed.

Results

To date 16 patients have completed the study. The peak increase in fasting blood glucose levels was seen the first morning (41% above baseline) after the epidural steroid injection. There was a statistically significant (p<.05) elevation in blood glucose levels above baseline for 7 days.

There was a positive correlation between HgA1c levels and percentage increase of blood glucose levels on day 1 (r=0.561, p=.012). No correlation was found between and day 1 percentage change of FBG levels and BMI (r=-0.213, p=.21), or years with DM (r=0.370, p=.08).

Conclusion

After epidural administration of depomedrol, there is a transient increase in fasting blood glucose levels that returns to near baseline after 7 days. The magnitude of increase is directly correlated with HgA1c levels.


References: Linn AJ, Simopoulos T. Changes in glycosylated hemoglobin levels after epidural steroid injections in diabetics. Anesthesiology 2007; 107: A1897.
Funding: none

Andrew Linn, M.D.
Nothing to disclose.