Effect of Intra-Articular Depot Betamethasone on Insulin Resistance in T2D

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Intra-articular corticosteroid injection of 1 mL of depot betamethasone was associated with a significantly transient increase in insulin resistance in all patients.
Intra-articular corticosteroid injection of 1 mL of depot betamethasone was associated with a significantly transient increase in insulin resistance in all patients.

Patients with type 2 diabetes who receive an intra-articulate corticosteroid injection of betamethasone at the knee joint may experience a significant increase in insulin resistance (IR) levels 1 day after the injection compared with baseline levels, according to a study published in the Journal of Clinical Rheumatology.

Researchers identified 11 patients with type 2 diabetes (patient group) to receive an intra-articulate depot betamethasone injection at the knee joint and 10 individuals to serve as the control group. The purpose of the study was to determine the effects of intra-articulate depot betamethasone at the knee joint on IR levels in individuals with type 2 diabetes. 

Study results demonstrated an increase in IR in patients with type 2 diabetes compared with the control group. The median ratio increase of blood glucose and IR 1 day after injection when compared with baseline was 1.7 and 4.1, respectively.

The median fasting blood glucose (FBG) and IR 1 day after injection in the patient group was 247±104 mg/dL (P =.004) and 20.8±7.01 (P =.0039), respectively, compared with a baseline mean of 148±51 mg/dL and median of 5.12±2.46. Interestingly, there was no difference in FBG and IR in the patient group from baseline levels 8 days after the intra-articulate injection.

A significant limitation of the study was the small sample size, which limits the significance of the findings and overall generalizability of the results. Further, this was not a randomized or blinded controlled trial, which would have increased the strength of the study.

Investigators concluded that there was a significant increase in IR level in patients with type 2 diabetes 1 day after an intra-articulate injection of betamethasone at the knee joint, with a higher mean percentage increase in IR compared with FBG. 

Clinicians should use caution when prescribing intra-articulate injection of betamethasone in patients with type 2 diabetes and should be vigilant in following up and monitoring closely those who require betamethasone injection to prevent long-term adverse events resulting from the acute changes observed in FBG and IR levels. In addition, clinicians should consider lifestyle modifications such as physical activity, weight loss, diet, and a more intense medical treatment plan that could assist in reducing the patient's IR level overall.

Reference

Habib G, Chernin M, Sakas F, Artul S, Jabbour A, Jabaly-Habib H. The impact of intra-articular depot betamethasone injection on insulin resistance among diabetic patients with osteoarthritis of the knee: a case-control study [published online December 1, 2017]. J Clin Rheumatol. doi: 10.1097/RHU.0000000000000614

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