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Hyperglycemia after repeated periocular dexamethasone injections in patients with diabetes.

Feldman-Billard S, Du Pasquier-Fediaevsky L, Héron E

Service de Médecine Interne, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France. s.feldman@quinze-vingts.fr

PURPOSE: To assess the hyperglycemic effect of 3 consecutive daily periocular steroid injections in patients with diabetes. DESIGN: Retrospective observational study in a national eye center. PARTICIPANTS: Twenty-five hospitalized patients with type 2 diabetes who received a subconjunctival (n = 11) or a peribulbar injection (n = 14) with 4 mg dexamethasone disodium phosphate once a day for 3 consecutive days for ocular conditions. METHODS: Baseline patient characteristics were recorded as well as serial blood glucose measurements and hypoglycemic interventions, both performed according to a written protocol. MAIN OUTCOME MEASURES: Serial blood glucose measurements and hypoglycemic interventions. RESULTS: Each ocular injection with dexamethasone was followed around 6 hours later by an increase of blood glucose up to a median doubling from baseline (+100% increase) followed by falls until the next injection, toward a median 13% increase from baseline before the next ocular injection. Older age (P<0.05), duration of diabetes (P = 0.01), and microangiopathy or macroangiopathy (P = 0.01) were associated with higher blood glucose rises. Using a 14-mmol/l threshold for intervention, the probability of requiring additional hypoglycemic treatment during ocular steroid therapy in patients with HbA1c >7.5% and up to 7.5% was 100% and 60%, respectively. CONCLUSIONS: Periocular injections with dexamethasone in patients with type 2 diabetes induce a marked hyperglycemic effect, similar to that observed during intravenous pulse methylprednisolone.

Published 2 October 2006 in Ophthalmology, 113(10): 1720-3.
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