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Effect of repeated transforaminal epidural low-dose dexamethasone injections on glucose profiles of diabetic and non-diabetic patients with low back pain

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We aimed to investigate the effect of repeated transforaminal epidural low-dose dexamethasone injections on glucose profiles and pituitary-adrenal axis functions of diabetic and non-diabetic patients with low back pain.


A total of 28 patients (ten diabetic [DM group] and 18 non-diabetic patients [non-DM group]) with low back pain were followed-up. Transforaminal epidural low-dose dexamethasone (1.65 mg) injections were repeated every 7–14 days for 8 weeks. Fasting blood sugar (FBS), hemoglobin A1c (HbA1c), morning plasma adrenocorticotropin (ACTH), and cortisol levels were measured at baseline and during the 8-week follow-up period.


There were no significant changes in FBS and HbA1c levels between baseline and 8-week follow-up period in both DM and non-DM groups (difference in FBS [95% confidence Interval, CI]: − 0.6 mg/dL [− 6.4, 5.1], p = 0.83 in the non-DM group, − 0.2 mg/dL [− 26.2, 25.8], p = 0.99 in the DM group; difference in HbA1c [95% CI] − 0.02% [− 0.1, 0.1], p = 0.69 in the non-DM group, 0.04% [− 0.3, 0.4], p = 0.79 in the DM group). There were no significant longitudinal changes in ACTH and cortisol levels (ACTH, p = 0.38 [baseline vs. 8 week], p = 0.58 [non-DM vs. DM]; cortisol, p = 0.52 [baseline vs. 8 week], p = 0.90 [non-DM vs. DM]).


Repeated transforaminal epidural low-dose dexamethasone injections provided no significant elevations in blood glucose or suppression of the pituitary-adrenal axis for two months from the first injection in both diabetic and non-diabetic patients. Our results indicate the intermediate-term safety of repeated transforaminal epidural low-dose dexamethasone injections with regard to the effect on glucose profile and pituitary-adrenal axis functions.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


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The authors would like to thank Dr. Masahiro Shiotani for his cooperation with this study.


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All authors contributed to the study’s conception and design. Material preparation, data collection and analysis were performed by RH, YO, KW and SK. The first draft of the manuscript was written by RH, HM, and SK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Shizuko Kosugi.

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Hoshino, R., Wakaizumi, K., Otsuka, Y. et al. Effect of repeated transforaminal epidural low-dose dexamethasone injections on glucose profiles of diabetic and non-diabetic patients with low back pain. J Anesth 37, 261–267 (2023).

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