Tanabe Kumiko, Ishihara Takuma, Nakamura Yoshimi, Iida Hiroki
Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan.
Pain Physician. 2025 Sep;28(5):E547-E554.
Glucocorticoids (GCs) are often administered locally to inhibit the synthesis and release of pro-inflammatory cytokines, thereby alleviating local pain. While GCs are known to exacerbate hyperglycemia, we previously reported changes in glucose levels following a single-dose dexamethasone injection in patients who did not have diabetes mellitus (DM). In patients without DM, blood glucose levels increased on the first day but were generally not critical. However, the exact changes in blood glucose levels due to GCs and the risk factors for blood glucose elevation in DM patients remain unclear.
To measure changes in glucose levels following a single-dose dexamethasone injection in patients with DM and identify the risk factors for hyperglycemia.
Cohort study.
Gifu University Hospital, Japan.
Fifty DM patients undergoing elective pulsed radiofrequency of the lumbar or sacral nerve root or radiofrequency of the lumbar medial branch of the posterior primary ramus were analyzed. Each patient received 0.1 mg/kg of dexamethasone and was subjected to interstitial glucose monitoring using a continuous glucose monitoring system. Hyperglycemia was defined as a blood glucose level >= 200 mg/dL. The area under the curve (AUC) for glucose levels >= 200 mg/dL was calculated. Risk factors for hyperglycemia were analyzed using an ordinal regression model, with AUC as the objective variable and 4 factors (glycosylated hemoglobin [HbA1c], age, body mass index, and pre-procedure glucose levels) as explanatory variables. Nonlinear regression models were used to predict the blood glucose trends.
Blood glucose levels increased immediately after the dexamethasone injections. The median (interquartile range) maximum glucose level was 328 (250-386) mg/dL, with a median time to peak of 592 (400-700) min. Among the 4 factors, age and HbA1c level were significant predictors of hyperglycemia (P = 0.035 and 0.023, respectively). Patients treated with insulin were predicted to have significantly higher blood glucose levels than those treated for DM with non-insulin medications or no pharmacological medications (P < 0.001).
Firstly, GCs are metabolized by cytochrome p450 3A4, and medications that affect this pathway may alter the clearance of GCs. Some of our patients were taking medications that influenced the cytochrome pathway. Secondly, preoperative insulin management details (dosing, timing, and types) were not fully documented. Thirdly, stress-induced hyperglycemia could not be ruled out. Finally, patients' meal timing and caloric intake were not recorded.
Patients with DM experienced significant hyperglycemia even after a single dose of dexamethasone. Age and HbA1c levels were risk factors for hyperglycemia. Higher preprocedural HbA1c levels, reflecting poorer daily glucose control, were associated with increased blood glucose levels.
糖皮质激素（GCs）常用于局部给药，以抑制促炎细胞因子的合成与释放，从而减轻局部疼痛。虽然已知糖皮质激素会加重高血糖，但我们之前报道了在非糖尿病（DM）患者中单次注射地塞米松后血糖水平的变化。在非糖尿病患者中，血糖水平在第一天会升高，但一般并不严重。然而，糖皮质激素导致的血糖水平的确切变化以及糖尿病患者血糖升高的危险因素仍不清楚。
测量糖尿病患者单次注射地塞米松后血糖水平的变化，并确定高血糖的危险因素。
队列研究。
日本岐阜大学医院。
分析了50例接受腰椎或骶神经根选择性脉冲射频或后支腰内侧支射频治疗的糖尿病患者。每位患者接受0.1mg/kg的地塞米松，并使用连续血糖监测系统进行组织间葡萄糖监测。高血糖定义为血糖水平≥200mg/dL。计算血糖水平≥200mg/dL的曲线下面积（AUC）。使用有序回归模型分析高血糖的危险因素，以AUC作为目标变量，4个因素（糖化血红蛋白[HbA1c]、年龄、体重指数和术前血糖水平）作为解释变量。使用非线性回归模型预测血糖趋势。
地塞米松注射后血糖水平立即升高。最大血糖水平的中位数（四分位间距）为328（250 - 386）mg/dL，达到峰值的中位时间为592（400 - 700）分钟。在这4个因素中，年龄和HbA1c水平是高血糖的显著预测因素（分别为P = 0.035和0.023）。预计接受胰岛素治疗的患者血糖水平显著高于使用非胰岛素药物或未使用药物治疗糖尿病的患者（P < 0.001）。
首先，糖皮质激素由细胞色素P450 3A4代谢，影响该途径的药物可能会改变糖皮质激素的清除率。我们的一些患者正在服用影响细胞色素途径的药物。其次，术前胰岛素管理细节（剂量、时间和类型）未得到充分记录。第三，不能排除应激性高血糖。最后，患者的用餐时间和热量摄入未被记录。
即使是单次注射地塞米松，糖尿病患者也会出现显著的高血糖。年龄和HbA1c水平是高血糖的危险因素。术前较高的HbA1c水平反映了日常血糖控制较差，与血糖水平升高有关。
