Use of a screening questionnaire to identify patients at risk of hyperglycemia prior to steroid injection therapy

Abstract

Objective. Patients with chronic pain considered for steroid injections are not consistently screened for undiagnosed or poorly controlled diabetes mellitus (DM) prior to steroid administration despite the known impact of corticosteroids on glucose control. A quality improvement project was undertaken to identify the prevalence of at-risk patients prior to steroid exposure through the development and implementation of a screening questionnaire. Subjects. Three hundred and five adult patients with chronic pain who were being considered for an outpatient steroid injection were interviewed. Method. Each patient was asked to complete an American Diabetes Association–validated diabetes mellitus screening questionnaire (ADAQ). In addition, patients responded to a set of nine questions that addressed common signs and symptoms of hyperglycemia. Results. The total prevalence of known DM in the study population was found to be 20% (60 patients), based on a documented history of diabetes mellitus. The ADAQ identified an additional 135 patients (45%) at high risk for undiagnosed DM. The full study questionnaire identified 143 patients (47.3%) who had no known history of diabetes mellitus as being at risk for hyperglycemia. In patients with known diabetes, five of nine symptom-based screening questions occurred with significantly frequency (P < 0.05): excessive thirst, excessive hunger, blurred vision, poor wound healing, and repeated infections. Conclusions. More than 60% of the patients screened had high risk of having inadequately treated DM. Thus, routine screening for DM should be considered in patients prior to treatment involving corticosteroids. The study questionnaire is a potentially cost-effective initial screening tool to determine which patients should undergo laboratory testing.