Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes

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.

Authors

Institutions

Publication Details

Journal
Diabetes Care
Published
2025-04-18
DOI
https://doi.org/10.2337/dc24-2841
Citations
15
Primary Topic
Neurological and metabolic disorders
Type
article
Field-Weighted Citation Impact
19.42

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes

Kátia Portero Sloan, Samer Nakhle, Vanita R. Aroda, Mary Simmons et al.
15 citations
Diabetes Care
Neurological and metabolic disorders
19.42
article

Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes

Kátia Portero Sloan, Samer Nakhle, Vanita R. Aroda, Mary Simmons, Allison Camacho, Deborah Branigan, David Guzman, Jonathan G. Ownby, Mark D. Leibowitz, Lisa Iannuzzi, Rodica Pop‐Busui, Leslie N. Aldrich, Kelly Paulus, Margaret Chang, Kathleen Wyne, Curtiss Puckett, Michael H. Shanik, Lindsey Sloan, Michael Zimmerman, Stanley H. Hsia, Irina Bancos, Vivian Fonseca, Oksana Hamidi, Jean Park, Yehuda Handelsman, John B. Buse, Julio Rosenstock, Iulia Cristina Tudor, Céline Hardy, Karen Atkinson, Timothy S. Bailey, Mark S. Kipnes, Richard Joseph Auchus, Gabriel Centeno, Dragana Lovre, M. Hamm, Richard E. Pratley, Terri Ryan, John C. Parker, Cecilia Rodríguez, Guillermo E. Umpierrez, Dan Lender, Maria Hurtado, Elena A. Christofides, Steven E. Kahn, Adline Ghazi, Lawrence Blonde, María Martin, Mira Wenker, Ralph A. DeFronzo, J. Botte, Rosario Rosal, Elizabeth Álvarez, Bradley Eilerman, Andrew Ahmann, Tamara Blanco Varela, Athena Philis‐Tsimikas, Shannon Williams, James W. Findling, Rita Gyurko, Lance Sloan, Robert S. Busch, Terence W. Nixon, Pratibha Rao, Sam Lerman, Rosario Sánchez, Albert B. Schultz, Daniel Einhorn, John Delgado, Colleen Jacobsen, Nashia Stephens, Harold J. Miller, Ronald S. Swerdloff, Tina K. Schlafly, Lauren Kruszon, Abbey Fruiterman, Narges Heidarpour, Andrew Eskeland, Rosina Ducote, Sasha Sandry, Franziska Gassaway, Kari Jaasko, Lourdes Garibay
article en
15 citations

Abstract

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.

Diabetes CareVol. 48(12)
University of North Carolina at Chapel Hill (US), Tulane University (US), Brigham and Women's Hospital (US), Scripps Health (US), Mayo Clinic (US), Harvard University (US), Emory University (US), The University of Texas at San Antonio Health Science Center (US), University of Washington (US), Medical College of Wisconsin (US), Wilmington University (US), University of Michigan (US), Medical City Dallas Hospital (US), Kidney Research UK (GB), St. Elizabeth Healthcare (US), A.M. Surgical (United States) (US), Columbus Oncology and Hematology Associates (US), VA Puget Sound Health Care System (US), AMCR Institute (US), Atlanta Diabetes Associates (US), Tarzana Treatment Centers (US), Michigan Medicine (US), Mayo Clinic in Arizona (US), Corcept Therapeutics (United States) (US), Translational Research Institute for Metabolism and Diabetes (US), Velocity Clinical Research (United States) (US), Scripps Whittier Diabetes Institute (US), Mayo Clinic in Florida (US), Center for Clinical Research (United States) (US), Albany Medical Center Hospital (US), The University of Texas Southwestern Medical Center (US)
American Diabetes Association, U.S. Department of Veterans Affairs, Amgen, Eli Lilly and Company, Pfizer, AstraZeneca, Sanofi, Emory University, Tulane University, Ionis Pharmaceuticals, Intarcia Therapeutics, Insulet Corporation, Neurocrine Biosciences, MannKind Corporation, Quest Diagnostics, Dexcom, Recordati Rare Diseases, Amryt Pharma, Novo Nordisk, Servier, H. Lundbeck A/S, Esperion Therapeutics, National Institutes of Health, Diabetes Research Center, Abbott Diabetes Care, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Research Resources, NIH Clinical Center, National Center for Advancing Translational Sciences
Openalex Percentile: Top 1%
Neurological and metabolic disorders
19.42
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.