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Equine veterinary journal2023; doi: 10.1111/evj.14003

Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation.

Abstract: Corticosteroids are a commonly used, inexpensive intra-articular treatment for osteoarthritis which may increase the risk for laminitis in horses due, in part, to hyperinsulinaemia. Humans with metabolic syndrome experience increases in insulin and glucose concentrations post-injection, but responses in horses are unknown. Objective: To determine the effect of a single intra-articular (IA) dose of triamcinolone acetate (TA) on blood insulin and glucose concentrations. Methods: Before-after study. Methods: Ten horses with normal insulin regulation as assessed by an oral sugar test received 18 mg of TA into one middle carpal joint. Insulin and glucose concentrations were evaluated at baseline and 4, 6, 8, 24, 48, and 72 h following IA corticosteroid injection. Differences from baseline were evaluated using a repeated measures ANOVA with Dunnett's multiple comparison testing or a Friedman test with Dunn's correction (significant at p < 0.05). Results: Mean ± SD blood insulin concentration post IA TA injection was increased at 6 h (15.8 ± 3.1 μIU/mL, p = 0.01), 24 h (23 ± 5.8 μIU/mL, p ≤ 0.001), and 48 h (29 ± 13 μIU/mL, p ≤ 0.01) compared to baseline (10 ± 12.3 μIU/mL), with the peak at 48 h. Median ± 95% CI blood glucose concentration post IA TA injection was increased at 6 h (112.7 ± 20.3 mg/dL, p = 0.006), 8 h (112.9 ± 21.4 mg/dL, p = 0.004), 24 h (122.6 ± 14.6, p ≤ 0.0001), and 48 h (123.5 ± 15.4 mg/dL, p ≤ 0.0001) compared to baseline (89.2 ± 6.6 mg/dL), with the peak at 48 h. Conclusions: Only horses with normal insulin regulation were evaluated. Conclusions: Blood insulin and glucose concentrations modestly increased for 48 h following IA TA.
© 2023 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2023-09-13 PubMed ID: 37705233DOI: 10.1111/evj.14003Google Scholar: Lookup
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Summary

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The abstract details a study examining the effects of intra-articular injections of the corticosteroid drug triamcinolone acetonide on blood insulin and glucose levels in healthy horses. The research indicates that these injections can lead to measurable increases in systemic insulin and glucose concentrations for up to 48 hours post-injection.

Objective of the Study

  • The objective of this study was to understand the impact of a single intra-articular dose of triamcinolone acetate (TA) on the blood insulin and glucose concentration in horses. It aimed to fill the knowledge gap generated due to limited evidence on the effects of this common treatment for osteoarthritis in horses.

Research Methods

  • The study used a before-after methodology on ten horses that have normal insulin regulation as measured by an oral sugar test.
  • Each horse received an injection of 18mg of TA into one of their middle carpal joints.
  • With base measurements taken for comparison, the insulin and glucose concentrations of the horses were evaluated at several time points – 4, 6, 8, 24, 48, and 72 hours after the injection.
  • The researchers used repeated measures ANOVA with Dunnett’s multiple comparison testing or a Friedman test with Dunn’s correction to evaluate deviations from the baseline measurements.

Results

  • The study found a significant increase in blood insulin concentration after the IA TA injection. This effect was observed at 6, 24, and 48 hours following the injection, and the peak occurred at 48 hours.
  • Similarly, there was a notable surge in blood glucose concentration at 6, 8, 24, and 48-hour time points when compared to baseline, with the peak at 48 hours.

Conclusions

  • The study concluded that the IA TA injection led to a modest increase in the blood insulin and glucose concentrations which lasted up to 48 hours in horses with normal insulin regulation.
  • This conclusion was drawn keeping in mind the limitation of the study that only included horses with normal insulin regulation. The effect of IA TA injections on horses with insulin dysregulation was not evaluated in this study.

Cite This Article

APA
Boger BL, Manfredi JM, Loucks AR, Salamey MZ, Kapeller LE, Fricano AG, Winkler A, Yob C, Colbath AC. (2023). Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation. Equine Vet J. https://doi.org/10.1111/evj.14003

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Boger, Brooke L
  • Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.
Manfredi, Jane M
  • Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.
Loucks, Abigail R
  • Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
Salamey, Maya Z
  • Department of Animal Science, College of Agriculture and Natural Sciences, Michigan State University, East Lansing, Michigan, USA.
Kapeller, Lydia E
  • Department of Animal Science, College of Agriculture and Natural Sciences, Michigan State University, East Lansing, Michigan, USA.
Fricano, Allie G
  • Department of Animal Science, College of Agriculture and Natural Sciences, Michigan State University, East Lansing, Michigan, USA.
Winkler, Ani
  • Department of Biochemistry and Molecular Biology, College of Agriculture and Natural Sciences, Michigan State University, East Lansing, Michigan, USA.
Yob, Chelsey
  • Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.
Colbath, Aimee C
  • Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.

Grant Funding

  • AA-22-0064 / Michigan Alliance for Animal Agriculture

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Citations

This article has been cited 3 times.
  1. Page AE, Johnson M, Parker JL, Jacob O, Poston R, Adams AA, Adam EN. The Effects of Intra-Articular Triamcinolone and Autologous Protein Solution on Metabolic Parameters in Horses. Animals (Basel) 2024 Aug 2;14(15).
    doi: 10.3390/ani14152250pubmed: 39123776google scholar: lookup
  2. Menzies-Gow NJ, Knowles EJ. Sodium-glucose transport protein 2 inhibitor use in the management of insulin dysregulation in ponies and horses. J Vet Pharmacol Ther 2025 Jan;48 Suppl 1(Suppl 1):31-40.
    doi: 10.1111/jvp.13470pubmed: 38984777google scholar: lookup
  3. Hallowell KL, Dembek K, Horne CR, Knych HK, Messenger KM, Schnabel LV. Systemic absorption of triamcinolone acetonide is increased from intrasynovial versus extrasynovial sites and induces hyperglycemia, hyperinsulinemia, and suppression of the hypothalamic-pituitary-adrenal axis. Front Vet Sci 2024;11:1388470.
    doi: 10.3389/fvets.2024.1388470pubmed: 38828366google scholar: lookup
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