Department of Medicine, Rambam Medical Center, Haifa.
J Clin Rheumatol. 2018 Jun;24(4):193-196. doi: 10.1097/RHU.0000000000000614.
The aim of this study was to evaluate the impact of intra-articular corticosteroid injection (IACI) of depot betamethasone at the knee joint on insulin resistance (IR).
Patients with type 2 diabetes, non-insulin treated, with painful osteoarthritis of the knee were requested to participate in our study. After consent, demographic, clinical, and laboratory parameters were documented in addition to fasting blood glucose (FBG) and fasting blood insulin levels just prior to IACI of 1 mL of depot betamethasone. Fasting blood glucose and fasting blood insulin levels were repeated the next day following the IACI and 8 days later. Age- and sex-matched group of patients with type 2 diabetes from the same clinic were recruited as a control group (case-control study). Insulin resistance was calculated using Homeostasis Model Assessment-Insulin Resistance. Mann-Whitney U test, χ test, and Wilcoxon signed rank tests were used for statistical analysis.
Eleven patients were recruited in the patients' group and 10 patients in the control group. Median FBG in the patients' group at baseline was 148 ± 51 mg/dL, and median IR was 5.12 ± 2.46. One day following the IACI, median FBG level was 247 ± 104 mg/dL (P = 0.004, compared with baseline), with median IR of 20.8 ± 7.01 (P = 0.0039). The median ratios of blood glucose and IR 1 day following the IACI compared with baseline were 1.7 and 4.1, respectively. Eight days following the IACI, mean FBG and IR levels were not significantly different from baseline.
Intra-articular corticosteroid injection of betamethasone at the knee joint among patients with diabetes was associated with a significant increase in IR levels compared with baseline levels, 1 day following the injection. The mean percentage of increase in IR was higher than that for FBG levels.
本研究旨在评估膝关节腔内注射倍他米松储库制剂对胰岛素抵抗（IR）的影响。
本研究邀请了未接受胰岛素治疗的 2 型糖尿病伴膝关节疼痛性骨关节炎患者参与。征得同意后，记录患者的人口统计学、临床和实验室参数，以及在膝关节腔内注射 1 毫升倍他米松储库制剂前的空腹血糖（FBG）和空腹胰岛素水平。在注射后第二天和 8 天后重复这些测量。从同一诊所招募了年龄和性别匹配的 2 型糖尿病患者作为对照组（病例对照研究）。使用稳态模型评估-胰岛素抵抗（HOMA-IR）计算胰岛素抵抗。采用 Mann-Whitney U 检验、卡方检验和 Wilcoxon 符号秩检验进行统计学分析。
患者组招募了 11 名患者，对照组招募了 10 名患者。患者组基线时的中位 FBG 为 148 ± 51mg/dL，中位 IR 为 5.12 ± 2.46。注射后第一天，中位 FBG 水平为 247 ± 104mg/dL（P=0.004，与基线相比），中位 IR 为 20.8 ± 7.01（P=0.0039）。注射后第一天，FBG 和 IR 与基线相比的中位数比值分别为 1.7 和 4.1。注射后 8 天，FBG 和 IR 水平与基线相比无显著差异。
与基线相比，膝关节腔内注射倍他米松储库制剂在糖尿病患者中与 IR 水平显著升高相关，注射后第一天即出现这种情况。IR 的平均增长率高于 FBG 水平。
