As common as the use of epidural steroids is, it is surprising the limited amount of data on the systemic endocrine effects they may cause. This may be of increased importance in patients who appear to be more susceptible to the adverse effects of steroids, which include patients with osteoporosis, a history of congestive heart failure, or diabetics. Increases in blood glucose levels after epidural steroid injections is well-known, but the data on it is almost entirely anecdotal; the effect this might have on diabetics in unknown.

Methods:

With this in mind, we undertook a case control study of changes that occur in HgA1c levels in patients after receiving epidural steroid injections. Inclusion criteria included a) HgA1c level checked within 150 days prior to epidural steroid injection b) HgA1c level checked within 90 days after epidural steroid injection. Exclusion criteria include a) variation in any previous 3 HgA1c levels of greater than 8% b) epidural, i.v., or oral steroids in prior 150 days to baseline HgA1c test c) Receiving steroids other than epidurally-administered in period between HgA1c tests being studied.

Difference in HgA1c levels were determined with paired t-test. Correlations were determined using Pearsons correlation coefficient. Statistical significance was determined by an alpha<0.05.

Results:

We found no change in HgA1c values in patients after receiving epidural steroids. The mean HgA1c in all patients (n=155) was 6.26% pre-steroid injection, and 6.27 post-injection (p<.01, SEM .003). There was no significant difference amongst insulin dependent diabetics, patients on oral medications alone, or patients using diet and exercise to control the blood sugars.

No correlation between changes in HgA1c levels and epidural steroids was attributable to age (r=-0.02, p=0.17), amount of steroid received (r=0.14, p=0.14), or timing of HgA1c test after epidural steroid injection (r=-0.02, p=0.32).