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Am Fam Physician. 2023;108(3):307-308

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Clinical Question

What are the change in and duration of hyperglycemia after intra-articular steroid injections in patients with diabetes mellitus?

Evidence-Based Answer

In patients with well-controlled type 2 diabetes, blood glucose levels may reach peak values of 165 to 500 mg per dL (9.16 to 27.75 mmol per L) at 2 to 84 hours after intra-articular steroid injections and return to baseline in 18 hours to 21 days. Patients with type 2 diabetes receiving injections of extended-release triamcinolone had no significant increase in blood glucose compared with a 23% increase in patients receiving crystalline suspension triamcinolone. Patients with type 2 diabetes showed a statistically significant, but s clinically questionable, increase in fructosamine levels of 4.1% above baseline, measured two to three weeks after intra-articular knee injections. Patients with poorly controlled diabetes should be informed of the potential risk of transient hyperglycemia following an intra-articular steroid injection and should closely monitor glucose levels, particularly on days 1 to 3 postinjection. (Strength of Recommendation: C, consensus opinion, disease-oriented evidence.)

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Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN’s Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

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