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Systemic effects of epidural methylprednisolone injection on glucose tolerance in diabetic patients.

Zufferey P, Bulliard C, Gremion G, Saugy M, So A - BMC Res Notes (2011)

Bottom Line: Looking at each individual there were marked differences especially after intra-articular injections.This is the first study to show that a single epidural steroid injection of 80 mg depot methylprednisolone had no effect on the glycemic control in diabetic patients.NCT01420497.

View Article: PubMed Central - HTML - PubMed

Affiliation: DAL (D├ępartement de l'appareil locomoteur), CHUV (Centre hospitalier universitaire vaudois), Lausanne, Switzerland. pascal.zufferey@chuv.ch.

ABSTRACT

Background: Several studies have shown that in diabetic patients, the glycemic profile was disturbed after intra-articular injection of corticosteroids. Little is known about the impact of epidural injection in such patients. The goal of this study was double, at first comparing the glycaemic profile in diabetic patients after a unique injection of 80 mg of acetate methylprednisolone either intra-articular or epidural and secondly to compare the amount of systemic diffusion of the drug after both procedures.

Methods: Seventeen patients were included. Glycemic changes were compared in 9 diabetic patients following intra-articular (4 patients) and epidural injections (5 patients).Epidural injections were performed using the sacral route under fluoroscopic control in patients with lumbar spinal stenosis. Diabetes control had to stable for more than 10 days and the renal function to be preserved. Blood glucose was monitored using a validated continuous measuring device (GMS, Medtronic) the day before and for two days following the injection. Results were expressed in the form of daily glycemic profiles and as by mean, peak and minimal values +/- SD. The urinary excretion of methylprednisolone after the 2 routes of injection was analyzed in 8 patients (4 in each group). Urine samples were cropped one hour before the injections, then 4 times during the first day and 3 times a week for 2 weeks. The measurements included the free and conjugated fraction

Results: The glycaemic profile remains unchanged with no significant changes in the group of the 5 diabetic patients receiving epidural injections.On the other end, the average peak and and mean values were enhanced up to 3 mmol/l above baseline two days after the infiltration in the groups of the 4 diabetic patients infiltrated intra-articular. The mean urinary excretion of the steroid was about ten times higher in the intra-articular versus epidural group: 7000 ng/ml versus 700 ng/ml. Looking at each individual there were marked differences especially after intra-articular injections.

Conclusion: This is the first study to show that a single epidural steroid injection of 80 mg depot methylprednisolone had no effect on the glycemic control in diabetic patients. The absence of glycemic control changes correlated well with the very low urinary excretion of the drug after epidural injection.

Trial registration: NCT01420497.

No MeSH data available.


Related in: MedlinePlus

Mean peak, mean and lowest blood glucose values+/_SD evolution before and after the infiltrations.
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Figure 1: Mean peak, mean and lowest blood glucose values+/_SD evolution before and after the infiltrations.

Mentions: At day 0, the mean blood glucose values were similar before steroid injections in the two groups. In the group of diabetic patients who received epidural injections, the glycaemic profile remained unchanged with no significant changes and very few individual differences (Figures 1 and 2). In contrast, the group of diabetic patients who received intra-articular injections showed mean elevation of peak blood sugar levels of 3 mmol/l two days after the infiltration (at day 3). These changes remain however not significant compared to baseline values due to marked individual variations (Figure 1). By cons, the peak, and mean values after the intra-articular were at day 3 significantly higher than after epidural injections (p< 0.05) although the baseline values were identical in both groups (Figure 2). No local or systemic complication or side effect following the infiltrations occurred in both groups.


Systemic effects of epidural methylprednisolone injection on glucose tolerance in diabetic patients.

Zufferey P, Bulliard C, Gremion G, Saugy M, So A - BMC Res Notes (2011)

Mean peak, mean and lowest blood glucose values+/_SD evolution before and after the infiltrations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298566&req=5

Figure 1: Mean peak, mean and lowest blood glucose values+/_SD evolution before and after the infiltrations.
Mentions: At day 0, the mean blood glucose values were similar before steroid injections in the two groups. In the group of diabetic patients who received epidural injections, the glycaemic profile remained unchanged with no significant changes and very few individual differences (Figures 1 and 2). In contrast, the group of diabetic patients who received intra-articular injections showed mean elevation of peak blood sugar levels of 3 mmol/l two days after the infiltration (at day 3). These changes remain however not significant compared to baseline values due to marked individual variations (Figure 1). By cons, the peak, and mean values after the intra-articular were at day 3 significantly higher than after epidural injections (p< 0.05) although the baseline values were identical in both groups (Figure 2). No local or systemic complication or side effect following the infiltrations occurred in both groups.

Bottom Line: Looking at each individual there were marked differences especially after intra-articular injections.This is the first study to show that a single epidural steroid injection of 80 mg depot methylprednisolone had no effect on the glycemic control in diabetic patients.NCT01420497.

View Article: PubMed Central - HTML - PubMed

Affiliation: DAL (D├ępartement de l'appareil locomoteur), CHUV (Centre hospitalier universitaire vaudois), Lausanne, Switzerland. pascal.zufferey@chuv.ch.

ABSTRACT

Background: Several studies have shown that in diabetic patients, the glycemic profile was disturbed after intra-articular injection of corticosteroids. Little is known about the impact of epidural injection in such patients. The goal of this study was double, at first comparing the glycaemic profile in diabetic patients after a unique injection of 80 mg of acetate methylprednisolone either intra-articular or epidural and secondly to compare the amount of systemic diffusion of the drug after both procedures.

Methods: Seventeen patients were included. Glycemic changes were compared in 9 diabetic patients following intra-articular (4 patients) and epidural injections (5 patients).Epidural injections were performed using the sacral route under fluoroscopic control in patients with lumbar spinal stenosis. Diabetes control had to stable for more than 10 days and the renal function to be preserved. Blood glucose was monitored using a validated continuous measuring device (GMS, Medtronic) the day before and for two days following the injection. Results were expressed in the form of daily glycemic profiles and as by mean, peak and minimal values +/- SD. The urinary excretion of methylprednisolone after the 2 routes of injection was analyzed in 8 patients (4 in each group). Urine samples were cropped one hour before the injections, then 4 times during the first day and 3 times a week for 2 weeks. The measurements included the free and conjugated fraction

Results: The glycaemic profile remains unchanged with no significant changes in the group of the 5 diabetic patients receiving epidural injections.On the other end, the average peak and and mean values were enhanced up to 3 mmol/l above baseline two days after the infiltration in the groups of the 4 diabetic patients infiltrated intra-articular. The mean urinary excretion of the steroid was about ten times higher in the intra-articular versus epidural group: 7000 ng/ml versus 700 ng/ml. Looking at each individual there were marked differences especially after intra-articular injections.

Conclusion: This is the first study to show that a single epidural steroid injection of 80 mg depot methylprednisolone had no effect on the glycemic control in diabetic patients. The absence of glycemic control changes correlated well with the very low urinary excretion of the drug after epidural injection.

Trial registration: NCT01420497.

No MeSH data available.


Related in: MedlinePlus