CGM-Based Glycemic Analysis After ESI

NCT ID: NCT07280780

Last Updated: 2025-12-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Total Enrollment

36 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-12-18

Study Completion Date

2026-12-31

Brief Summary

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The goal of this clinical study is to learn how blood glucose levels change after an epidural steroid injection (ESI) with dexamethasone in adults. It will specifically compare the glycemic response between patients with type 2 diabetes and those without diabetes.

The main questions it aims to answer are:

Does the injection cause higher or longer-lasting blood glucose elevation in diabetic patients compared to non-diabetic patients? How do the mean glucose level and Time in Range (TIR) change after the injection in both groups?

Researchers will compare a Type 2 Diabetes group to a Non-Diabetes group to see the differences in glycemic fluctuations using a continuous glucose monitoring (CGM) device.

Participants will:

* Wear a small CGM sensor on their arm for about 15 days to monitor blood glucose levels continuously
* Receive an epidural steroid injection containing 5 mg of dexamethasone on Day 3
* Visit the clinic 3 times (Day 1, Day 3, and Day 15) for sensor attachment, the injection procedure, and data collection

Detailed Description

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Epidural steroid injections (ESIs) are a widely used non-surgical treatment for radicular pain caused by spinal conditions such as herniated discs and spinal stenosis. While effective for pain relief, the systemic absorption of corticosteroids (e.g., dexamethasone) can induce temporary hyperglycemia, which poses potential risks, particularly for patients with type 2 diabetes mellitus (T2DM).

Previous studies on post-ESI hyperglycemia have largely relied on self-monitoring of blood glucose (SMBG), which captures only intermittent glucose data and may miss significant glycemic excursions, such as postprandial spikes or nocturnal hypoglycemia. This study aims to overcome these limitations by using a Continuous Glucose Monitoring (CGM) system to provide a comprehensive, time-series analysis of glycemic fluctuations.

Objectives:

To compare glycemic changes (mean glucose, Time in Range \[TIR\], Time Above Range \[TAR\]) following an epidural steroid injection with 5 mg of dexamethasone between a type 2 diabetes group and a non-diabetes control group.

To investigate the correlation between baseline HbA1c levels and the magnitude of post-injection glycemic variability.

Study Design: This is a prospective, observational, comparative study conducted at a single center (Korea University Anam Hospital). A total of 36 participants (18 in the T2DM group and 18 in the Non-DM group) will be enrolled.

Study Procedures:

Visit 1 (Day 1 - Screening \& Baseline):

* Participants provide informed consent and undergo screening.
* Baseline HbA1c is measured.
* A CGM sensor (Abbott FreeStyle Libre 2) is attached to the participant's upper arm.
* Participants receive education on CGM use and are instructed to maintain their usual diet and medication.
* Baseline Data Collection: Glucose levels are monitored for 2 days (Day 1-2) to establish a baseline profile before the injection.

Visit 2 (Day 3 - Intervention):

* Participants undergo the scheduled epidural steroid injection (cervical or lumbar) using 5 mg of dexamethasone.
* The procedure is performed under fluoroscopic guidance according to standard clinical practice.

Visit 3 (Day 15 - Follow-up \& Data Collection):

* Participants return to the clinic for follow-up.
* The CGM sensor is removed, and the stored glycemic data is downloaded.
* Pain intensity (Numeric Rating Scale, NRS) and any adverse events are recorded.

Statistical Analysis: The primary endpoints (changes in mean daily glucose and TIR) will be analyzed using a Linear Mixed Model (LMM) to account for repeated measures. Fixed effects will include Group (DM vs. Non-DM), Time (Baseline vs. Post-injection), and the Group-by-Time interaction. Patient demographics (e.g., age, BMI) will be included as covariates if significant differences are observed at baseline. A p-value of \<0.05 will be considered statistically significant.

This study will provide high-resolution data on the duration and severity of steroid-induced hyperglycemia, contributing to safer pain management protocols for diabetic patients.

Conditions

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Type 2 Diabetes (T2DM) Hyperglycemia Radicular Pain Spinal Stenosis Intervertebral Disc Herniation

Keywords

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epidural steroid injection Continuous Glucose Monitoring Dexamethasone Glycemic Variability Time in range

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Group D (Type 2 Diabetes)

Patients diagnosed with Type 2 Diabetes Mellitus who are scheduled for an epidural steroid injection.

Epidural Steroid Injection

Intervention Type PROCEDURE

Administration of 5 mg Dexamethasone via epidural route (cervical or lumbar) under fluoroscopic guidance.

Continuous Glucose Monitoring

Intervention Type DEVICE

A sensor attached to the upper arm to monitor interstitial glucose levels continuously for 15 days.

Group C (Non-Diabetes)

Patients without diabetes who are scheduled for an epidural steroid injection.

Epidural Steroid Injection

Intervention Type PROCEDURE

Administration of 5 mg Dexamethasone via epidural route (cervical or lumbar) under fluoroscopic guidance.

Continuous Glucose Monitoring

Intervention Type DEVICE

A sensor attached to the upper arm to monitor interstitial glucose levels continuously for 15 days.

Interventions

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Epidural Steroid Injection

Administration of 5 mg Dexamethasone via epidural route (cervical or lumbar) under fluoroscopic guidance.

Intervention Type PROCEDURE

Continuous Glucose Monitoring

A sensor attached to the upper arm to monitor interstitial glucose levels continuously for 15 days.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Adults aged 20 to 60 years.
* Patients scheduled for cervical or lumbar epidural steroid injection at the pain clinic.
* Patients capable of understanding and using a Continuous Glucose Monitoring (CGM) device.

Exclusion Criteria

* Patients currently taking or administering steroid medications.
* Patients with Type 1 Diabetes Mellitus.
* Patients with Cushing's disease.
* Patients who have received an epidural steroid injection within the last 3 months.
* Patients with a known allergy to contrast media.
* Patients taking anticoagulants or antiplatelet agents.
* Patients unable to use a Continuous Glucose Monitoring (CGM) device.
Minimum Eligible Age

20 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Korean Pain Society

UNKNOWN

Sponsor Role collaborator

Korea University Anam Hospital

OTHER

Sponsor Role lead

Responsible Party

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Sunmin Kim

Clinical Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sunmin Kim, M.D.

Role: STUDY_DIRECTOR

Korea University Anam Hospital

Locations

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Korea University Anam Hospital

Seoul, Seoul, South Korea

Site Status

Countries

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South Korea

Central Contacts

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Sunmin Kim, M.D.

Role: CONTACT

Phone: +82-2-920-5632

Email: [email protected]

Facility Contacts

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Sunmin Kim, M.D.

Role: primary

Other Identifiers

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K2025-2728-002

Identifier Type: -

Identifier Source: org_study_id