Hyperglycemia after repeated periocular dexamethasone injections in patients with diabetes

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 HbA(1c) > 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.