Abstract

Glucose control in older adults with diabetes following intra-articular and epidural triamcinolone acetonide injections

Author(s): Connie Valdez*, Timothy Nguyen, Sunny A Linnebur, Danielle Fixen

Corticosteroid injections are widely used as part of a multimodal approach to manage pain in various areas of the body. These injections are often considered prior to resorting to more invasive options such as surgery and joint replacement. Common indications for corticosteroid injections include osteoarthritis, shoulder pain, and lumbar spine pain. Corticosteroid injections are typically administered Intra-Articular (IA) or epidural, and include agents such as methylprednisolone acetate, and triamcinolone acetonide, which is available as Immediate-Release (TA-IR) and Extended-Release (ER). Of these agents, TA-IR is the most studied and widely available and will be the primary focus of this review. Epidural and IA triamcinolone are absorbed both locally and systemically and have prolonged clearance compared to intravenous triamcinolone. Since metabolic abnormalities, including hyperglycemia, are common with corticosteroids, patients with diabetes who receive IA and epidural corticosteroid injections could be at higher risk of glucose excursions compared to patients without diabetes. The duration and extent of this risk, however, is not well described and needs to be further examined to help delineate the risks of corticosteroid injections in patients with diabetes.