Difficult-to-Control Diabetes:
Is Cortisol at Play?

Daniel Einhorn, MD; John Buse, MD, PhD; Ralph DeFronzo, MD; Juan Pablo Frias, MD, and Christopher Lucci, MD, share their insights and perspectives on the connection between difficult-to control T2DM and untreated hypercortisolism:

• Almost a quarter of patients with type 2 diabetes (T2DM) require 3 or more medications to manage their disease, and even then, many patients have difficulty getting their diabetes under control¹

• Elevated cortisol activity can exacerbate the pathophysiology of T2DM and can counter the impact of traditional anti-diabetic medications, making diabetes control challenging^2-6

• Studies emerging over the last two decades suggest that up to 10% of patients with T2DM may have hypercortisolism^7-11

• Patients with treatment-resistant T2DM should therefore be evaluated for hypercortisolism

• Treating the underlying hypercortisolism is important in these patients because managing comorbidities (alone) has not significantly reduced morbidity and mortality^12,13

Daniel Einhorn, MD
Meeting Moderator
Vice President
Endocrine Strategy
Corcept Therapeutics
Menlo Park, CA

John Buse, MD, PhD
University of North Carolina
School of Medicine
UNC Diabetes and Endocrinology Clinic
Chapel Hill, NC

Ralph DeFronzo, MD
University of Texas
Health Science Center
San Antonio, TX

Juan Pablo Frias, MD
Velocity Clinical Research
Los Angeles, CA

Christopher Lucci, MD
Diabetes and Cardiovascular of Rockport
Rockport, TX

 

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References

1. Fang M, et al. N Engl J Med. 2021;384(23):2219-2228.
2. Scaroni C, et al. Endocr Rev. 2017;38(3):189-219.
3. Mazziotti G, et al. Trends Endocrinol Metab. 2011;22(12):499-506.
4. Pivonello R, et al. Neuroendocrinology. 2010;92(suppl 1):77-81.
5. Mason IC, et al. Diabetologia. 2020;63(3):462-472.
6. Thau L, et al. StatPearls [Internet]. Updated August 29, 2022. Accessed February 3, 2023. https://www.ncbi.nlm.nih.gov/books/NBK538239/
7. Chiodini I, et al. Eur J Endocrinol. 2005;153(6):837-844.
8. Catargi B, et al. J Clin Endocrinol Metab. 2003;88(12):5808-5813.
9. Costa DS, et al. J Diabetes Complications. 2016;30(6):1032-1038.
10. Leon-Justel A, et al. J Clin Endocrinol Metab. 2016;101(10):3747-3754.
11. Steffensen C, et al. Horm Metab Res. 2019;51(1):62-68.
12. Petramala L, et al. Endocrine. 2020;70(1):150-163.
13. Morelli V, et al. Front Endocrinol (Lausanne). 2022;13:898084.

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