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

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Hypercortisolism, a condition of excess cortisol, affects nearly a quarter of type 2 diabetes patients with uncontrolled blood sugar despite medication. This highlights a potential target for improving glycemic control in diabetes management.

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Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Diabetes Research

Background:

  • Type 2 diabetes management often fails to achieve glycemic targets in a significant patient population.
  • Hypercortisolism is a potential, yet under-recognized, contributor to hyperglycemia in type 2 diabetes.

Purpose of the Study:

  • To determine the prevalence of hypercortisolism in individuals with type 2 diabetes and inadequately controlled glycemia.
  • To identify factors associated with hypercortisolism in this population.

Main Methods:

  • Prospective, observational study involving 1,057 individuals with type 2 diabetes on multiple glucose-lowering medications.
  • Screening using a 1-mg dexamethasone suppression test (DST) with post-DST cortisol >1.8 μg/dL defining hypercortisolism.
  • Logistic regression analysis to identify associated characteristics.

Main Results:

  • The prevalence of hypercortisolism was 23.8% (252/1,057).
  • Higher prevalence was observed in those with cardiac disorders (33.3%) and on multiple antihypertensives (36.6%).
  • Associated factors included specific diabetes and blood pressure medications, older age, lower BMI, non-Latino/Hispanic ethnicity, and use of fibrates or analgesics.

Conclusions:

  • Hypercortisolism is prevalent in approximately one-quarter of type 2 diabetes patients with suboptimal glycemic control.
  • Identifying and addressing hypercortisolism may offer a new strategy for improving glucose management in this challenging patient group.