Stepan Jeffrey G, London Daniel A, Boyer Martin I, Calfee Ryan P
Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO; Washington University School of Medicine in St. Louis, St. Louis, MO; Washington University in St. Louis Institute of Clinical and Translational Sciences, St. Louis, MO.
Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO; Washington University School of Medicine in St. Louis, St. Louis, MO; Washington University in St. Louis Institute of Clinical and Translational Sciences, St. Louis, MO.
J Hand Surg Am. 2014 Apr;39(4):706-12. doi: 10.1016/j.jhsa.2014.01.014.
To quantify diabetic patients' change in blood glucose levels after corticosteroid injection for common hand diseases and to assess which patient-level risk factors may predict an increase in blood glucose levels.
Patients were recruited for this case-crossover study in the clinic of fellowship-trained hand surgeons at a tertiary care center. Patients with diabetes mellitus type 1 or 2, who received a corticosteroid injection, recorded the morning fasting blood glucose levels for 14 days after the injection. Fasting glucose levels on days 1 to 7 after injection qualified as case data; levels on days 10 to 14 provided control data. A mixed model with a priori contrasts was used to compare postinjection blood glucose levels with baseline levels. We used a linear regression model to determine patient predictors of a postinjection rise in blood glucose levels.
Of 67 patients recruited for the study returned, 40 (60%) completed blood glucose logs. There was a significant increase in fasting blood glucose levels after injection limited to postinjection days 1 and 2. Among patient risk factors in the linear regression model, type 1 diabetes and use of insulin each predicted a postinjection increase in blood glucose levels from baseline, whereas higher glycated hemoglobin levels did not predict increases.
Corticosteroid injections in the hand transiently increase blood glucose levels in diabetic patients. Patients with type 1 diabetes and insulin-dependent diabetics are more likely to experience this transient rise in blood glucose levels.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
量化糖尿病患者因常见手部疾病接受皮质类固醇注射后血糖水平的变化，并评估哪些患者层面的风险因素可能预测血糖水平升高。
在一家三级医疗中心，由接受过专科培训的手外科医生在门诊为该病例交叉研究招募患者。1型或2型糖尿病患者接受皮质类固醇注射后，记录注射后14天的晨起空腹血糖水平。注射后第1至7天的空腹血糖水平作为病例数据；第10至14天的水平作为对照数据。使用带有先验对比的混合模型将注射后的血糖水平与基线水平进行比较。我们使用线性回归模型来确定注射后血糖水平升高的患者预测因素。
在招募的67例研究患者中，40例（60%）完成了血糖记录。注射后空腹血糖水平仅在注射后第1天和第2天有显著升高。在线性回归模型中的患者风险因素中，1型糖尿病和胰岛素使用各自预测了注射后血糖水平相对于基线的升高，而较高的糖化血红蛋白水平并未预测升高情况。
手部皮质类固醇注射会使糖尿病患者的血糖水平短暂升高。1型糖尿病患者和胰岛素依赖型糖尿病患者更有可能经历这种血糖水平的短暂升高。
研究类型/证据水平：治疗性III级。
