From the Guidelines
A corticosteroid injection can significantly impact your Hemoglobin A1c (HbA1c) level, particularly if you have diabetes or prediabetes, as it can induce hyperglycemia in 56-86% of individuals, according to a 2023 study published in Diabetes Care 1. When considering the effect of corticosteroids on HbA1c levels, it's essential to understand that these medications can cause insulin resistance, leading to elevated blood sugar levels for several days to weeks after injection.
- The type and duration of action of the glucocorticoid must be considered in determining appropriate insulin treatments, as daily-ingested intermediate-acting glucocorticoids such as prednisone can reach peak plasma levels in 4-6 hours and have pharmacologic actions that can last through the day 1.
- Individuals with diabetes who require corticosteroid injections may need more frequent blood glucose monitoring for 1-2 weeks after the injection, and temporary adjustments to diabetes medications may be necessary to maintain good glucose control during this period.
- The impact of corticosteroids on HbA1c levels can be significant, and healthcare providers should be informed about any recent cortisone injections to accurately interpret A1c test results, as the temporary rise in blood glucose could affect the reading, which reflects average blood sugar over the past 2-3 months.
- It is crucial to consider the potential effects of corticosteroids on glucose control and adjust treatment plans accordingly to minimize the risk of hyperglycemia and its associated complications, such as infections and cardiovascular events 1.
From the FDA Drug Label
Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required.
Corticosteroid injections can impact Hemoglobin A1c (HbA1c) levels by increasing blood glucose concentrations, which may require adjustments to antidiabetic agents.
- This is a key consideration for patients with diabetes or those at risk of developing diabetes.
- Monitoring of blood glucose levels and HbA1c is recommended for patients receiving corticosteroid injections. 2
From the Research
Impact of Corticosteroid Injections on Hemoglobin A1c (HbA1c) Levels
- The relationship between corticosteroid injections and HbA1c levels has been studied in various contexts, including diabetic patients with hand conditions 3, upper- and lower-extremity injections 4, subacromial corticosteroid injections for shoulder pathology 5, trigger finger treatment 6, and chronic obstructive pulmonary disease (COPD) exacerbation 7.
- Research suggests that corticosteroid injections can lead to a transient elevation in serum glucose levels in diabetic patients, with the degree of elevation varying depending on factors such as the patient's pre-injection HbA1c level, the dose and location of the injection, and the patient's demographic characteristics 3, 4, 5, 6.
Factors Influencing the Impact on HbA1c Levels
- Pre-injection HbA1c levels have been shown to be a significant predictor of post-injection blood glucose elevation, with patients having higher HbA1c levels experiencing greater elevations in blood glucose 3, 4, 5.
- The location of the injection can also impact blood glucose levels, with injections in the knee resulting in significant increases in fasting blood glucose, whereas injections in the upper extremity do not appear to have a significant effect 4.
- The dose of corticosteroid used can also influence the impact on HbA1c levels, with higher doses potentially leading to greater elevations in blood glucose 7.
Clinical Implications
- Patients with higher pre-injection HbA1c levels should be counseled to monitor their post-injection glucose levels more closely, as they are at greater risk of significant elevations in blood glucose 3, 4, 5.
- Clinicians should consider the potential impact of corticosteroid injections on HbA1c levels when managing diabetic patients, particularly those with poor glucose control or those receiving multiple injections 4, 7.