MON-518 Assessing Glycemic Excursions in Patients with Type 2 Diabetes Mellitus Receiving Epidural Steroid Injections

Abstract Disclosure: A. Lee: None. J. Gilman: None. J. Saunders: None. K. Slinchenkova: None. Y. Chen: None. N. Shaparin: None. A. Vydyanathan: None. N. Suda: None. Background: Glucocorticoid injections are frequently used to manage pain. Possible metabolic side effects such as hyperglycemia raise concerns for providers when considering administration to patients with pre-existing dysglycemia.1 Currently, there is insufficient data identifying the specific metabolic factors that predispose certain patients to experiencing greater glycemic excursions following glucocorticoid administration.2 The aim of this study is to evaluate the impact of epidural glucocorticoid injections on glycemia in patients with Type 2 Diabetes (T2DM) utilizing changes in plasma fructosamine levels. Additionally, it seeks to identify metabolic variables associated with 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 (< 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=34) were 34% male with an average age of 67 years and BMI of 32.87 kg/m2. The average baseline HbA1c was 7.3%, corresponding to a fructosamine level of 332 µmol/L. At baseline, the average eGFR was 73mL/min/BSA with an average total cholesterol of 170 mg/dL, HDL of 46 mg/dL, LDL of 98 mg/dL and triglycerides of 134 mg/dL. Prior to enrollment, 69% of patients were on metformin, 29% were on insulin, and 26% were on a glucagon-like peptide 1 receptor agonist. There was no significant change in fructosamine levels between the pre- and post-glucocorticoid injection period. Conclusions: Consistent with our previous findings, analysis of this larger data set again demonstrates statistically insignificant glycemic variability following glucocorticoid administration. These results reaffirm that many patients with T2DM can safely receive glucocorticoid injections without experiencing significant glycemic excursions. Moving forward, the study population can be expanded to include patients with higher baseline glucose levels and greater metabolic dysfunction. Presentation: Monday, July 14, 2025