Study Finds Minimal Diabetes Risk from Intra-Articular Corticosteroid Injections

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A recent study published in Clinical Diabetes indicates that Intra-articular corticosteroid (IACS) injections, commonly used for arthritis treatment, present a minimal risk of accelerating diabetes for most patients. While these injections are known to cause temporary elevations in blood glucose levels, the study suggests that they have limited long-term impact on glycemic control.

Methodology:

Nearly half of Americans with diabetes also have arthritis, raising concerns about glycemic control for those receiving IACS injections.
Researchers from Mayo Clinic in Minnesota conducted a retrospective cohort study, utilizing electronic health records from 1169 adults who had received IACS injections in a large joint between 2012 and 2018.
The study analyzed A1C levels 18 months before and after the injections.
The team assessed participants for greater-than-expected increases in A1C (defined as an increase of more than 0.5% above expected) after the injection, and examined rates of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome in the 30 days following the injection.

Key Findings:

Nearly 16% of individuals experienced a greater-than-expected increase in A1C after an IACS injection.
A1C levels rose by an average of 1.2% in the greater-than-expected group, while decreasing by an average of 0.2% in the average group.
One patient experienced severe hyperglycemia linked to the injection.
A baseline A1C level above 8% was the only factor associated with a greater-than-expected increase in the marker after an IACS injection.

Clinical Implications:

The study suggests that while most patients do not experience a significant increase in A1C after IACS injections, clinicians should counsel patients with suboptimally controlled diabetes about potential risks of further hyperglycemia following these injections.

Source: The study was led by Terin T. Sytsma, MD, of Mayo Clinic in Rochester, Minnesota.

Limitations:

The retrospective nature of the study limits its ability to establish causation.
The population studied was from one county in Minnesota and lacked racial or ethnic diversity.
Details about the injections, such as location and total dose, were not available.
The study did not include a control group.

Disclosures: The study was funded by Mayo Clinic and the National Center for Advancing Translational Sciences, with no relevant disclosures reported by the authors.