Screening for Hyperglycemia Prior to Steroid Injections for Chronic Pain

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As corticosteroids are known to affect glucose control, their use in the management of chronic pain may be contraindicated in patients with undiagnosed or poorly controlled diabetes mellitus.
As corticosteroids are known to affect glucose control, their use in the management of chronic pain may be contraindicated in patients with undiagnosed or poorly controlled diabetes mellitus.

The majority of patients being considered for corticosteroid injections to treat chronic pain may be at high risk for untreated diabetes mellitus, according to a recent study published in Pain Medicine.

As corticosteroids are known to affect glucose control, their use in the management of chronic pain may be contraindicated in patients with undiagnosed or poorly controlled diabetes mellitus. Researchers sought to develop a cost-effective tool to identify patients at risk for diabetes mellitus prior to steroid exposure. A total of 300 adults with chronic pain (average age, 52 years) being considered for steroid injections were asked to complete an American Diabetes Association-validated diabetes mellitus screening questionnaire (ADAQ), as well as a 9-item questionnaire addressing common signs and symptoms of hyperglycemia.

Within this cohort, 60 participants (20%) had previously been diagnosed with diabetes mellitus; an additional 133 patients were deemed to be at high risk for undiagnosed diabetes mellitus, for a total of 195 patients screening positive using the ADAQ. 

Using the second study questionnaire, 184 patients screened positive, including 143 participants previously undiagnosed with diabetes mellitus. Of the 9 symptom-based questions on this tool, 5 were found to be significantly correlated with symptoms reported by patients with a previous diagnosis. These included excessive thirst (P =.03), excessive hunger (P =.02), blurred vision (P =4.7 x 10-3), poor wound healing (P =3.3 x 10-4), and repeated infections of the skin, gums, or bladder (P =1.5 x 10-5).

The researchers reported several limitations to their study, including its small sample size and the absence of blood tests.

“The high prevalence of positive screening for the risk [for] undiagnosed or poorly controlled diabetes mellitus (65%) using the study questionnaire in the study population was unexpected and very concerning,” the researchers noted. “[G]reater attention should be paid to screening patients for diabetes mellitus prior to corticosteroid exposure.”

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Reference

Nguyen VH, Goel AP, Yerra S, Hamill-Ruth R. Use of a screening questionnaire to identify patients at risk of hyperglycemia prior to steroid injection therapy Pain Med. 2018;19:2109-2114.

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