Extended-Release Versus Immediate-Release Triamcinolone Acetonide in Patients Who Have Knee Osteoarthritis and Type 2 Diabetes Mellitus

Abstract

Background: Intra-articular corticosteroid injections may cause hyperglycemia (glucose level >180 mg/dL). In a phase 2 study of 33 patients who had osteoarthritis of the knee and type 2 diabetes mellitus, triamcinolone acetonide extended-release (TA-ER) was associated with minimal glycemic control disruption compared with triamcinolone acetonide immediate-release (TA-IR). This post hoc analysis characterizes the clinical relevance of these results.

Methods: Patients who had symptomatic osteoarthritis of the knee for ≥6 months, type 2 diabetes mellitus for ≥1 year, and hemoglobin A1c ≥6.5 and ≤9.0% were randomized to receive an intra-articular injection of either TA-ER or TA-IR. Changes in continuous glucose monitor daily glucose level, percentage of time in or above the target glucose range (>70 to 180 mg/dL), time to glucose level 250 mg/dL and maximum glucose level >250 mg/dL, and glycemic variability were evaluated.

Results: Across postinjection days 1 to 3, the TA-ER group (n = 18) had a lower median change from baseline in maximum glucose level (92.3 versus 169.1 mg/dL), a reduced percentage of time with a glucose level >250 mg/dL (12 versus 26%), a smaller proportion of patients who had a maximum glucose level >250 mg/dL (50 versus 93%), and a greater percentage of time in the target glucose range (62 versus 48%) versus the TA-IR group (n = 15). There was less glycemic variability and lower glucose spikes in the TA-ER versus TA-IR group. Median times to glucose level 250 mg/dL (44 versus 6 hours) and maximum glucose level (34 versus 13 hours) were significantly longer in the TA-ER versus TA-IR group.

Conclusions: Use of TA-ER was associated with a clinically meaningful reduction in hyperglycemia versus TA-IR.

Keywords: hyperglycemia; intra-articular injection; knee osteoarthritis; triamcinolone acetonide extended-release; type 2 diabetes mellitus.