Epidural Steroids Cause Blood Glucose Spike in Patients With DM

Daniel M. Keller, PhD

April 21, 2011

April 21, 2011 (Denver, Colorado) — Epidural steroid injections (ESIs), often used to treat various spinal disorders, including spinal stenosis, cause a transient but significant rise in the blood glucose levels of patients with diabetes mellitus (DM), Matthew McGirt, MD, assistant professor of neurological surgery and director, Clinical Spine Research, Vanderbilt Medical Center, Nashville, Tennessee, reported here at the American Association of Neurological Surgeons (AANS) 79th Annual Meeting.

"As many as 13.6% of patients can have both concurrent spinal stenosis and [DM]," he calculated. Corticosteroids received by either the oral or intraarticular route have been shown to result in elevations in plasma glucose levels, but up to this point the effect of ESIs on glucose levels was not known.

Dr. McGirt and colleagues prospectively enrolled 30 patients with DM and asked them to track their blood glucose levels twice daily at predetermined times for 2 weeks before and after ESIs. The researchers collected hemoglobin A1c determinations 2 weeks before and 2 weeks after the injections. The patients had experienced symptoms of lumbar spinal stenosis for at least 3 months and had to have a computed tomographic myelogram or magnetic resonance image confirming the stenosis, as well as a diagnosis of DM. Injections of 40 mg betamethasone into the epidural space were performed with an interlaminar approach under fluoroscopic guidance.

The investigators reported a statistically significant rise in blood glucose levels after ESIs, from a mean of 160 ± 47 mg/dL preinjection to 286 ± 111 mg/dL 2 hours later. The average increase was 126 mg/dL (78%), which was a statistically significant difference from a 0 mg/dL increase (P < .001).

"You can see, however, that this elevation in systemic blood glucose was only a transient effect," Dr. McGirt noted. "So while there was a systemic elevation [at] 2 hours, as early as 2 days following the injection, the glucose levels were back to baseline."

Dr. Alon Mogilner

The estimated half-life of the blood glucose was only approximately 1 day. Further evidence that the ESIs did not cause any chronic change in blood glucose levels was that the hemoglobin A1c determinations after the injections were no different from preinjection values. The postinjection response was not related to preinjection control of the DM.

"[ESIs] were noted to cause a significant increase in blood glucose levels in diabetics only in the periprocedural period," Dr. McGirt concluded. He advised counseling patients with diabetes who are candidates for ESIs that their blood glucose readings may be elevated just after the injection, but that they will return to baseline levels within 2 days.

Commenting on the study, Alon Mogilner, MD, PhD, director of functional and restorative neurosurgery for the North Shore–Long Island Jewish Health System and Hofstra Medical School in Great Neck, New York, and past-president of the AANS Pain Section, said the study addressed a long-standing question in the field.

"It's something that's always been thought about and discussed, and everyone has seen it in patients," he told Medscape Medical News. "I think given the fact that the glucose normalizes itself rather soon...it's sort of reassuring to the patients that you can go ahead" with the procedure.

Dr. McGirt has received research support from Globus Medical and DePuy Spine. Dr. Mogilner is a consultant to and has received honoraria from Medtronic and has received research support from Medtronic and St. Jude Medical.

American Association of Neurological Surgeons (AANS) 79th Annual Meeting: "Effects of Epidural Steroid Injections on Blood Glucose Levels in Patients with Diabetes Mellitus." Presented April 12, 2011.

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