Acute Glycemic Response to Epinephrine-Containing Lidocaine in Patients with Type II Diabetes Undergoing Dental Extraction: A Prospective Comparative Study

Epinephrine-containing local anesthetics are widely used in dental procedures to enhance anesthetic efficacy and provide hemostasis. However, their systemic effects on epinephrine's impact on blood glucose levels in diabetic patients remain a clinical concern, as epinephrine can stimulate both glycogenolysis and gluconeogenesis. This presents a persistent clinical concern for the growing population of diabetic patients undergoing dental procedures, making it crucial to understand the actual glycemic impact of standard anesthetic formulations. The objective of this study is to evaluate and compare the effects of epinephrine-containing local anesthesia (lidocaine 2% with epinephrine 1:80,000) on blood glucose levels in healthy individuals versus type II diabetic patients undergoing dental extraction procedures.

This prospective comparative clinical study was conducted at the University of Kufa College of Dentistry from October 2024 to February 2025. Forty patients (20 healthy controls and 20 patients with type 2 diabetes) aged 20-72 years who required mandibular tooth extraction were enrolled in this study. Blood glucose levels were measured using a glucometer before local anesthesia administration (2% lidocaine with 1:80,000 epinephrine) and 10 minutes post-injection. Statistical analysis was performed using independent samples t-tests and chi-square tests with SPSS version 28.0, with a significance level of p < 0.05.

Pre-anesthesia glucose levels were significantly higher in diabetic patients compared to healthy controls (167.65±SD vs. 105.85±SD mg/dL, p < 0.001). Post-anesthesia glucose levels showed a modest increase in both groups: healthy patients (108.70±SD mg/dL) and diabetic patients (170.80±SD mg/dL). However, the change from baseline was not statistically significant within each group (p=0.066 for healthy patients, p=0.082 for diabetic patients), with a mean absolute change of +2.85±6.92 mg/dL in healthy controls and +3.15±8.47 mg/dL in patients with diabetes, indicating that epinephrine 1:80,000 concentration did not produce clinically significant acute glycemic alterations.

The observed non-significant glycemic changes in this study suggest that the amount of epinephrine in a single dental cartridge (1:80,000) is insufficient to cause acute, clinically meaningful hyperglycemia in patients with adequate glycemic control. These results stand in contrast to other recent studies that reported statistically significant elevations, a discrepancy that may be due to differences in sample size, study design, or monitoring duration. Our findings indicate that the physiological stress of inadequate anesthesia may pose a greater risk to glycemic stability than the pharmacological effect of the vasoconstrictor itself.

Administration of lidocaine 2% with epinephrine 1:80,000 for dental extraction procedures does not cause clinically significant acute changes in blood glucose levels in either healthy or well-controlled type II diabetic patients. These findings support the safe use of standard epinephrine concentrations in routine dental procedures for diabetic patients with adequate glycemic control.