Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections into the Subacromial Space of the Shoulder

Document Type : RESEARCH PAPER


1 Washington University in St. Louis School of Medicine Department of Orthopaedic Surgery, St. Louis, MO, USA

2 The Rothman Institute at Thomas Jefferson University, Philadelphia PA, USA


Background: Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing
pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose
levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on
blood glucose levels in diabetic patients with shoulder pathology.
Methods: Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromial
corticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucose
and most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily to
confirm their fasting morning glucose level for 10 days post-injection.
Results: Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of <7% had an average rise
in blood glucose of 38 mg/dL compared to 98 mg/dL in the poorly controlled group after injection (P<0.001). Wellcontrolled
patients’ glucose levels returned to near baseline levels around post-injection day 8, while poorly controlled
patients levels remained elevated. Similarly, insulin-dependent diabetic patients had an average increase in fasting
glucose level of 99 mg/dL versus 50 mg/dL in non-insulin-dependent diabetic patients (P<0.001).
Conclusion: After corticosteroid injection, patients with well-controlled diabetes experience smaller elevations and
faster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similar
findings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of blood
glucose elevation while maintaining therapeutic benefit.


Main Subjects

1. Arslan S, Celiker R. Comparison of the efficacy of
local corticosteroid injection and physical therapy for
the treatment of adhesive capsulitis. Rheumatol Int.
2001; 21(1):20-3.
2. Cole BF, Peters KS, Hackett L, Murrell GA. Ultrasoundguided
versus blind subacromial corticosteroid
injections for subacromial impingement syndrome:
a randomized, double-blind clinical trial. Am J Sports
Med. 2016; 44(3):702-7.
3. Hart L. Corticosteroid and other injections in the
management of tendinopathies: a review. Clin J Sport
Med. 2011; 21(6):540-1.
4. Lorbach O, Kieb M, Scherf C, Seil R, Kohn D, Pape D.
Good results after fluoroscopic-guided intra-articular
injections in the treatment of adhesive capsulitis of
the shoulder. Knee Surg Sports Traumatol Arthrosc.
2010; 18(10):1435-41.
5. Warner JJ. Frozen shoulder: diagnosis and management.
J Am Acad Orthop Surg. 1997; 5(3):130-40.
6. Ranalletta M, Rossi LA, Bongiovanni SL, Tanoira I,
Elizondo CM, Maignon GD. Corticosteroid injections
accelerate pain relief and recovery of function
compared with oral NSAIDs in patients with adhesive
capsulitis: a randomized controlled trial. Am J Sports
Med. 2016; 44(2):474-81.
7. Habib GS, Miari W. The effect of intra-articular
triamcinolone preparations on blood glucose levels in
diabetic patients: a controlled study. J Clin Rheumatol.
2011; 17(6):302-5.
8. Stepan JG, London DA, Boyer MI, Calfee RP. Blood glucose
levels in diabetic patients following corticosteroid
injections into the hand and wrist. J Hand Surg Am.
2014; 39(4):706-12.
9. Even JL, Crosby CG, Song Y, McGirt MJ, Devin CJ. Effects
of epidural steroid injections on blood glucose levels
in patients with diabetes mellitus. Spine (Phila Pa
1976). 2012; 37(1):E46-50.
10. Kim N, Schroeder J, Hoffler CE, Matzon JL, Lutsky
KF, Beredjiklian PK. Elevated hemoglobin A1C levels
correlate with blood glucose elevation in diabetic
patients following local corticosteroid injection in the
hand: a prospective study. Plast Reconstr Surg. 2015;
11. Habib GS, Abu-Ahmad R. Lack of effect of corticosteroid
injection at the shoulder joint on blood
glucose levels in diabetic patients. Clin Rheumatol.
2007; 26(4):566-8.
12. Lasker RD. The diabetes control and complications
trial. Implications for policy and practice. N Engl J
Med. 1993; 329(14):1035-6.
13. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley
SE, Cull CA, et al. Association of glycaemia with
macrovascular and microvascular complications of
type 2 diabetes (UKPDS 35): prospective observational
study. BMJ. 2000; 321(7258):405-12.
14. Ahmed N. Advanced glycation endproducts--role in
pathology of diabetic complications. Diabetes Res Clin
Pract. 2005; 67(1):3-21.
15. Giori NJ, Ellerbe LS, Bowe T, Gupta S, Harris AH.
Many diabetic total joint arthroplasty candidates
are unable to achieve a preoperative hemoglobin
A1c goal of 7% or less. J Bone Joint Surg Am. 2014;