Kaderli B, Kivanc S A, Inan U U, Ersoy C, Yucel A A, Yilmaz S, Avci R
Department of Ophthalmology, Uludag University Faculty of Medicine, Bursa, Turkey.
Eur Rev Med Pharmacol Sci. 2014;18(18):2609-14.
To evaluate the influence of posterior subtenon injection of 40 mg of triamcinolone acetonide (TA) on blood glucose, cortisol and adrenocorticotrophic hormone (ACTH) in patients with clinically significant diabetic macular oedema.
This prospective clinical study included 33 type 2 diabetic patients assigned to receive subtenon injection of 40 mg of TA (study group: 20 patients, 9 women and 11 men, mean age 60.8 ± 10.1 years) or subtenon injection of 1 ml of saline solution (control group: 13 patients, 7 women and 6 men, mean age 57.9 ± 7.5 years) as an adjunct to focal/grid laser therapy. Pre-injection laboratory tests consisted of fasting blood glucose (FBG), glicolised hemoglobin (HbA1c), fructosamine, ACTH and cortisol. Post-injection measurements were performed in a following schedule: FBG in day 1; FBG, ACTH and cortisol at week 1; FBG, fructosamine, ACTH and cortisol at month 1, 2 and 3. HbA1c was also measured at 3 months. The mean ± SD values of groups at each visit were compared. The time-related changes in the parameters in each group were also analyzed using SPSS (Statistical Package for Social Sciences) for Windows 15.0 software.
Pre-injection FBG, HbA1c, fructosamine, ACTH and cortisol were similar in both groups (p > 0.05 for all). Pre-injection and final HbA1c values were similar in the study (8.6% ± 1.9 and 8.7% ± 1.8, respectively) and control groups (8.6% ± 1.7 and 8.5% ± 1.8, respectively) (p > 0.05 for all). None of the patients had a decrease in plasma cortisol that decreased below normal values at either time point. There was no statistically significant difference between groups and between each visit in groups according to FBG levels, blood fructosamine, ACTH and cortisol levels (p > 0.05 for all). No adverse event was observed.
Subtenon injection of 40 mg of TA does not increase blood sugar levels significantly, and it does not suppress blood cortisol or ACTH levels at 1 week or later in patients with diabetes mellitus. Subtenon injection of 40 mg TA seems to be safe in respect to elevation of blood sugar levels or systemic corticosteroid pathways.
评估在患有具有临床意义的糖尿病性黄斑水肿的患者中，于眼球筋膜囊下注射40mg曲安奈德（TA）对血糖、皮质醇和促肾上腺皮质激素（ACTH）的影响。
这项前瞻性临床研究纳入了33例2型糖尿病患者，这些患者被分配接受眼球筋膜囊下注射40mg TA（研究组：20例患者，9例女性和11例男性，平均年龄60.8±10.1岁）或眼球筋膜囊下注射1ml生理盐水（对照组：13例患者，7例女性和6例男性，平均年龄57.9±7.5岁）作为局部/格栅样激光治疗的辅助治疗。注射前实验室检查包括空腹血糖（FBG）、糖化血红蛋白（HbA1c）、果糖胺、ACTH和皮质醇。注射后测量按以下时间表进行：第1天测FBG；第1周测FBG、ACTH和皮质醇；第1、2和3个月测FBG、果糖胺、ACTH和皮质醇。在3个月时也测量HbA1c。比较每次就诊时两组的均值±标准差。还使用适用于Windows 15.0的SPSS（社会科学统计软件包）软件分析每组参数随时间的变化。
两组注射前的FBG、HbA1c、果糖胺、ACTH和皮质醇相似（所有p>0.05）。研究组（分别为8.6%±1.9和8.7%±1.8）和对照组（分别为8.6%±1.7和8.5%±1.8）注射前和最后的HbA1c值相似（所有p>0.05）。在任何时间点，均无患者血浆皮质醇下降至低于正常值。根据FBG水平、血果糖胺、ACTH和皮质醇水平，组间以及组内每次就诊之间均无统计学显著差异（所有p>0.05）。未观察到不良事件。
在糖尿病患者中，眼球筋膜囊下注射40mg TA不会显著升高血糖水平，且在1周或更晚时间不会抑制血皮质醇或ACTH水平。就血糖水平升高或全身皮质类固醇途径而言，眼球筋膜囊下注射40mg TA似乎是安全的。
