Citations 1
Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes
Buse, John B. , Kahn, Steven E. , Aroda, Vanita R. , Auchus, Richard J. , Busch, Robert S. , Christofides, Elena A. , DeFronzo, Ralph A. , Eilerman, Bradley , Findling, James W. , Handelsman, Yehuda , Miller, Harold J., Ownby, Jonathan G., Parker, John C. , Philis‐Tsimikas, Athena , Rosenstock, Julio , Shanik, Michael H., Sloan, Lance L., Tudor, Iulia Cristina , Schlafly, Tina K. , Einhorn, Daniel , Investigators*, CATALYST, Kruszon, Lauren, Fruiterman, Abbey, Handelsman, Yehuda, Heidarpour, Narges, Ownby, Jonathan G., Stephens, Nashia, Aroda, Vanita R., Gyurko, Rita, Rao, Pratibha, Paulus, Kelly, Kipnes, Mark, Ryan, Terri, Shanik, Michael H., Iannuzzi, Lisa, Umpierrez, Guillermo, Centeno, Gloria, Eskeland, Andrew, Swerdloff, Ronald S., Ruiz, Elizabeth, Park, Jean, Hurtado, Maria, Ghazi, Adline , Hamm, M., Ducote, Rosina, Blonde, Lawrence , Williams, Shannon, Wyne, Kathleen , Aldrich, Lindsey, Ahmann, Andrew , Branigan, Deborah , Nakhle, Samer, Sandry, Sasha, Rosal, Rosario, Hardy, Cashmere, Sloan, Lance , Sloan, Kátia Portero , Lerman, Sam, Simmons, Mary, Auchus, Richard J., Varela, Tamara Blanco, Gassaway, Franziska, DeFronzo, Ralph A., Puckett, Curtiss, Atkinson, Karen, Zimmerman, Michael, Jacobsen, Colleen, Wenker, Matthew, Schultz, Austin, Lender, Dan, Camacho, Allison, Leibowitz, Mark D., Sánchez, Rosario, Delgado, John , Jaasko, Kari, Hsia, Stanley H. , Rodríguez, Cecilia, Guzman, David , Garibay, Lourdes, Chang, Margaret, Nixon, Tatyana, Christofides, Elena A , DeFronzo, Ralph A , Eilerman, Bradley , Fonseca, Vivian , Handelsman, Yehuda , Rosenstock, Julio , Umpierrez, Guillermo E. , Schlafly, Tina K , Philis-Tsimikas, Athena , Kahn, Steven , Buse, John B , Bailey, Timothy S. , Bancos, Irina , Fonseca, Vivian , Hamidi, Oksana , Pratley, Richard E. , Sloan, Lance L., Investigators*, CATALYST, Handelsman, Yehuda, Ownby, Jonathan G., Aroda, Vanita R., Shanik, Michael H., Umpierrez, Guillermo, Centeno, Gloria, Ruiz, Elizabeth, Aldrich, Lindsey, Botte, Jennifer, Hardy, Cashmere, Martin, Maria Jesus , Lovre, Dragana , Simmons, Mary, Auchus, Richard J., Pop‐Busui, Rodica , DeFronzo, Ralph A., Zimmerman, Michael, Wenker, Matthew, Schultz, Austin, Chang, Margaret, Nixon, Tatyana
Diabetes Care | May 7, 2025 | Volume: 48 | Issue: 12 | Pages: 2012-2020
OBJECTIVE Despite the use of multiple glucose-lowering medications, glycemic targets are not met in a significant fraction of people with type 2 diabetes. In this prospective, observational study we assessed the prevalence of hypercortisolism, a potential contributing factor to inadequate glucose control. RESEARCH DESIGN AND METHODS Individuals with type 2 diabetes and HbA1c 7.5%–11.5% (58–102 mmol/mol) on two or more glucose-lowering medications with or without micro-/macrovascular complications or taking multiple blood pressure–lowering medications were screened with a 1-mg dexamethasone suppression test. Common causes of false-positive DSTs were excluded. The primary end point was the prevalence of hypercortisolism, defined as post-DST cortisol >1.8 μg/dL (50 nmol/L). Characteristics associated with hypercortisolism were assessed with multiple logistic regression. The percentage and characteristics of participants with hypercortisolism and adrenal imaging abnormalities were also assessed. RESULTS Post-DST cortisol was unsuppressed in 252 of 1,057 participants (prevalence 23.8%; 95% CI 21.3, 26.5). Hypercortisolism prevalence was 33.3% among participants with cardiac disorders and 36.6% among those taking three or more blood pressure–lowering medications. Adrenal imaging abnormalities were reported in 34.7% of participants with hypercortisolism. Use of sodium–glucose cotransporter 2 inhibitors (odds ratio 1.558), maximum-dose glucagon-like peptide 1 receptor agonists (1.544), tirzepatide (1.981), or a higher number of blood pressure–lowering medications (1.390); older age (1.316); BMI <30 kg/m2 (1.639); non-Latino/Hispanic ethnicity (3.718); and use of fibrates (2.676) or analgesics (1.457) were associated with higher prevalence (all P < 0.03). CONCLUSIONS Hypercortisolism was associated with hyperglycemia in approximately one-quarter of individuals with inadequately controlled type 2 diabetes despite multiple medications.