7463 Assessing Glycemic Excursions in Patients with Type 2 Diabetes Mellitus Receiving Epidural Steroid Injections
Authors: Saunders Jamia , Lee Audrey , Slinchenkova Kateryna , Chen Ying , Vydyanathan Amaresh , Shaparin Naum , Suda Nisha 
Published: October 2024

Disclosure: J. Saunders: None. A. Lee: None. K. Slinchenkova: None. Y. Chen: None. A. Vydyanathan: None. N. Shaparin: Research Investigator; Self; Heron Therapeutics, AceIRX Pharmaceuticals, Averitas Pharma. N. Suda: None.

Background: Glucocorticoid injections are frequently used to manage pain; however, they can potentially cause metabolic side effects such as hyperglycemia. This raises concerns for providers when considering administration to patients with pre-existing hyperglycemia. Presently, there is insufficient data pinpointing the specific metabolic factors that make certain patients prone to experiencing greater glycemic excursions following glucocorticoid administration. The purpose of this novel study is to evaluate the impact of epidural glucocorticoid injections on glycemia in patients with Type 2 Diabetes (T2DM) by utilizing changes in plasma fructosamine levels, and to identify which metabolic variables contribute to greater glycemic excursions after glucocorticoid therapy. Methods: This prospective observational cohort study protocol was reviewed and approved by the Institutional Review Board on 2/13/20. All patients participating provided written informed consent. Adult patients with T2DM who were steroid naïve for ≥ 6 months and scheduled to receive an epidural steroid injection were enrolled at an academic medical center. Patients with a diagnosis of insulin-deficient diabetes (autoimmune or pancreatogenic), recent (&lt; 6 months) steroid use, current pregnancy, or on dialysis were excluded. Once enrolled, pre-glucocorticoid injection serum blood samples were collected for baseline fructosamine levels, hemoglobin A1c (HbA1c), estimated glomerular filtration rate (eGFR), hepatic and lipid levels. Serum fructosamine levels were collected again 2 weeks post-glucocorticoid injection. Non-parametric analyses of these continuous variables with a p-value of 0.05 were utilized. Results: Study participants (n=22) were 27% male with an average age of 67 years, and a BMI of 32.85 kg/m2. The average baseline HbA1c was 7.3%, which corresponds to a fructosamine level of 318 µmol/L. At baseline, the average eGFR was 74mL/min/BSA with an average total cholesterol of 169 mg/dL, HDL of 47 mg/dL, LDL of 96 mg/dL and triglycerides of 125 mg/dL. Prior to enrollment, 77% of patients were on metformin, 41% were on insulin, and 14% were on a glucagon-like peptide 1 (GLP-1) receptor agonist. There was no significant change in fructosamine levels between the pre- and post-glucocorticoid injection period (320 µmol/L). The corresponding change in HbA1c (0.27%) was non-significant. Conclusions: This initial data demonstrates safe and statistically insignificant glycemic variability in response to glucocorticoid administration. Moving forward, we can broaden our study population by incorporating patients with higher baseline glucose levels and more severe metabolic disease parameters. Preliminary data suggests that providers do not need to be overly concerned and could adopt a more liberal approach when determining T2DM patients' eligibility for glucocorticoid injections.

Presentation: 6/1/2024