Glycemic Effects of Musculoskeletal Steroid Injection: Methods for a Systematic Review and Meta-Analysis

Background: Orthopedic related conditions are the leading contributor to disability worldwide, and corticosteroid injections are a staple in the management of musculoskeletal injuries, such as osteoarthritis, bursitis, or tendinopathy. Importantly, corticosteroid injections are not without risk, and certain populations, specifically, diabetic patients, are currently not eligible for injection, for fear of their glycemic effect, and thus unable to reap these life changing benefits. However, existing data on glycemic effects of corticosteroid injection are mixed, and there is no true systematic review to date summarizing the available data. Objective: Systematically synthesize risks of corticosteroid injection in diabetic patients. Purpose: This manuscript presents the intended methods for a systematic review and meta-analysis on the glycemic effects of corticosteroid injection. Methods: We will follow the Institute of Medicine, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidance. We will conduct a systematic search of PubMed (and Ovid MEDLINE), Cochrane Library Databases, Scopus, CINAHL, and clinical trial registries. Included in the review will be randomized trials, cohort studies, case-control studies, and case series, that evaluate the association between measures of blood glucose and steroid injection. Abstract screening and full-text screening will be independently dually reviewed. We will use the Cochrane revised Risk of Bias tool to assess risk of bias and GRADE to assess the overall quality of evidence. Results: We will present results for all studies and perform subgroup analyses, when possible, to evaluate impact of injection type, location, frequency and dose.