The Prevalence of Hypercortisolism in Patients with Type 2 Diabetes and Microvascular Complications: A Prospective Observational Case-Control Study

OBJECTIVE: The goal of this study was to examine the prevalence of hypercortisolism in patients with type 2 diabetes (T2D), and the association of cortisol with microvascular complications. MATERIALS AND METHODS: This prospective observational case-control, single-center study included 107 patients with T2D. After evaluating their microvascular complications, the patients were divided into 2 groups. Group 1 consisted of 57 patients with complications, and group 2 consisted of 50 patients without. Serum 08h cortisol and adrenocorticotropic hormone (ACTH), 09h cortisol after a short dexamethasone test (DEX cortisol), traditional risk factors, and lipid and inflammatory profiles were determined and correlated among the 2 groups. RESULTS: Prevalence of hypercortisolism in patients with T2D was 6.3%, in patients with complications it was 10.5%, and 2.0% in patients without complications. In group 1 we found higher basal cortisol and ACTH, and higher low-density lipoprotein cholesterol (LDL-C) and C-reactive protein (CRP) levels when compared to group 2 (p < 0.05). A more positive correlation of cortisol with CRP was found in group 1 compared to group 2 (rho = 0.255, p = 0.011). We did not find a significant difference in sex, body mass index (BMI), treatment modality, diabetes duration, triglyceride, or fibrinogen levels among the groups. CONCLUSIONS: Higher serum cortisol levels and higher prevalence of hypercortisolism were significantly associated with diabetic microvascular complications. Systemic inflammation indicators positively correlated with cortisol levels and microvascular complications. This suggests a potential connection between cortisol, inflammation, and microvascular complications in T2D. Further research is needed to clarify the causality of this relationship.