{"doi":"10.2337/dc24-2841","title":"Prevalence of Hypercortisolism in Difficult-to-Control Type 2 Diabetes","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.","journal":"Diabetes Care","year":2025,"id":509701,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":28,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9656,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":249041,"name":"Steven E. Kahn","orcid":"0000-0001-7307-9002","position":1,"is_corresponding":false},{"id":298021,"name":"Vanita R. Aroda","orcid":"0000-0002-7706-4585","position":2,"is_corresponding":false},{"id":369854,"name":"Richard J. Auchus","orcid":"0000-0001-6815-6181","position":3,"is_corresponding":false},{"id":841302,"name":"Timothy S. Bailey","orcid":"0000-0003-4178-3462","position":4,"is_corresponding":false},{"id":239586,"name":"Irina Bancos","orcid":"0000-0001-9332-2524","position":5,"is_corresponding":false},{"id":1364714,"name":"Robert S. Busch","orcid":"0000-0002-7172-2815","position":6,"is_corresponding":false},{"id":1364715,"name":"Elena A. Christofides","orcid":"0000-0002-1595-9906","position":7,"is_corresponding":false},{"id":53900,"name":"Ralph A. DeFronzo","orcid":"0000-0002-8581-6273","position":8,"is_corresponding":false},{"id":1364716,"name":"Bradley Eilerman","orcid":"0000-0003-3962-3136","position":9,"is_corresponding":false},{"id":1364717,"name":"James W. Findling","orcid":"0000-0003-3101-5320","position":10,"is_corresponding":false},{"id":19503,"name":"Vivian Fonseca","orcid":"0000-0002-3381-7151","position":11,"is_corresponding":false},{"id":511501,"name":"Oksana Hamidi","orcid":"0000-0002-7367-3885","position":12,"is_corresponding":false},{"id":1084998,"name":"Yehuda Handelsman","orcid":"0000-0001-7830-0247","position":13,"is_corresponding":false},{"id":1365555,"name":"Harold J. Miller","orcid":null,"position":14,"is_corresponding":false},{"id":1365556,"name":"Jonathan G. Ownby","orcid":null,"position":15,"is_corresponding":false},{"id":603297,"name":"John C. Parker","orcid":"0000-0003-0428-2706","position":16,"is_corresponding":false},{"id":231685,"name":"Athena Philis‐Tsimikas","orcid":"0000-0002-3986-9630","position":17,"is_corresponding":false},{"id":231670,"name":"Richard E. Pratley","orcid":"0000-0002-2912-1389","position":18,"is_corresponding":false},{"id":320000,"name":"Julio Rosenstock","orcid":"0000-0001-8324-3275","position":19,"is_corresponding":false},{"id":1365557,"name":"Michael H. Shanik","orcid":null,"position":20,"is_corresponding":false},{"id":1365558,"name":"Lance L. Sloan","orcid":null,"position":21,"is_corresponding":false},{"id":228523,"name":"Guillermo E. Umpierrez","orcid":"0000-0002-3252-5026","position":22,"is_corresponding":false},{"id":1364718,"name":"Iulia Cristina Tudor","orcid":"0000-0002-4229-2940","position":23,"is_corresponding":false},{"id":1364719,"name":"Tina K. Schlafly","orcid":"0009-0006-7769-3046","position":24,"is_corresponding":false},{"id":840711,"name":"Daniel Einhorn","orcid":null,"position":25,"is_corresponding":false},{"id":1365559,"name":"CATALYST Investigators*","orcid":null,"position":26,"is_corresponding":false},{"id":1365560,"name":"Lauren Kruszon","orcid":null,"position":28,"is_corresponding":false},{"id":1365561,"name":"Abbey Fruiterman","orcid":null,"position":30,"is_corresponding":false},{"id":1365562,"name":"Narges Heidarpour","orcid":null,"position":32,"is_corresponding":false},{"id":1365563,"name":"Nashia Stephens","orcid":null,"position":34,"is_corresponding":false},{"id":1365564,"name":"Rita Gyurko","orcid":null,"position":36,"is_corresponding":false},{"id":1365565,"name":"Pratibha Rao","orcid":null,"position":37,"is_corresponding":false},{"id":1365566,"name":"Kelly Paulus","orcid":null,"position":38,"is_corresponding":false},{"id":1365567,"name":"Mark Kipnes","orcid":null,"position":39,"is_corresponding":false},{"id":1365568,"name":"Terri Ryan","orcid":null,"position":40,"is_corresponding":false},{"id":1365569,"name":"Lisa Iannuzzi","orcid":null,"position":42,"is_corresponding":false},{"id":1365570,"name":"Guillermo Umpierrez","orcid":null,"position":43,"is_corresponding":false},{"id":1365571,"name":"Gloria Centeno","orcid":null,"position":44,"is_corresponding":false},{"id":1365572,"name":"Andrew Eskeland","orcid":null,"position":46,"is_corresponding":false},{"id":278836,"name":"Ronald S. Swerdloff","orcid":"0000-0001-6084-6604","position":47,"is_corresponding":false},{"id":1365573,"name":"Elizabeth Ruiz","orcid":null,"position":48,"is_corresponding":false},{"id":252522,"name":"Jean Park","orcid":null,"position":49,"is_corresponding":false},{"id":1365574,"name":"Maria Hurtado","orcid":null,"position":50,"is_corresponding":false},{"id":460704,"name":"Adline Ghazi","orcid":"0000-0001-7799-1998","position":51,"is_corresponding":false},{"id":1365575,"name":"M. Hamm","orcid":null,"position":52,"is_corresponding":false},{"id":1365576,"name":"Rosina Ducote","orcid":null,"position":54,"is_corresponding":false},{"id":839347,"name":"Lawrence Blonde","orcid":"0000-0003-0492-6698","position":55,"is_corresponding":false},{"id":1365577,"name":"Shannon Williams","orcid":null,"position":56,"is_corresponding":false},{"id":640223,"name":"Kathleen Wyne","orcid":"0000-0003-4118-8727","position":57,"is_corresponding":false},{"id":1365578,"name":"Lindsey Aldrich","orcid":null,"position":58,"is_corresponding":false},{"id":231673,"name":"Andrew Ahmann","orcid":"0000-0002-4544-5404","position":59,"is_corresponding":false},{"id":522237,"name":"Deborah Branigan","orcid":"0000-0003-2822-587X","position":60,"is_corresponding":false},{"id":671454,"name":"Samer Nakhle","orcid":null,"position":61,"is_corresponding":false},{"id":1365579,"name":"Sasha Sandry","orcid":null,"position":62,"is_corresponding":false},{"id":1364720,"name":"J. Botte","orcid":"0000-0003-0061-008X","position":64,"is_corresponding":false},{"id":1365580,"name":"Rosario Rosal","orcid":null,"position":66,"is_corresponding":false},{"id":1365581,"name":"Cashmere Hardy","orcid":null,"position":68,"is_corresponding":false},{"id":1364721,"name":"Lance Sloan","orcid":"0000-0002-0370-4914","position":69,"is_corresponding":false},{"id":1364722,"name":"Kátia Portero Sloan","orcid":"0000-0001-8776-561X","position":70,"is_corresponding":false},{"id":1365582,"name":"Sam Lerman","orcid":null,"position":71,"is_corresponding":false},{"id":57226,"name":"María Martin","orcid":"0000-0001-5454-2815","position":72,"is_corresponding":false},{"id":656635,"name":"Dragana Lovre","orcid":"0000-0002-2607-8768","position":73,"is_corresponding":false},{"id":1365583,"name":"Mary Simmons","orcid":null,"position":74,"is_corresponding":false},{"id":231193,"name":"Rodica Pop‐Busui","orcid":"0000-0002-2042-1350","position":76,"is_corresponding":false},{"id":1365584,"name":"Tamara Blanco Varela","orcid":null,"position":77,"is_corresponding":false},{"id":1365585,"name":"Franziska Gassaway","orcid":null,"position":79,"is_corresponding":false},{"id":351945,"name":"Curtiss Puckett","orcid":null,"position":81,"is_corresponding":false},{"id":1365586,"name":"Karen Atkinson","orcid":null,"position":83,"is_corresponding":false},{"id":261476,"name":"Michael Zimmerman","orcid":null,"position":84,"is_corresponding":false},{"id":1084372,"name":"Colleen Jacobsen","orcid":null,"position":85,"is_corresponding":false},{"id":1365587,"name":"Matthew Wenker","orcid":null,"position":86,"is_corresponding":false},{"id":1365588,"name":"Austin Schultz","orcid":null,"position":87,"is_corresponding":false},{"id":1365589,"name":"Dan Lender","orcid":null,"position":88,"is_corresponding":false},{"id":1365590,"name":"Allison Camacho","orcid":null,"position":90,"is_corresponding":false},{"id":1365591,"name":"Mark D. Leibowitz","orcid":null,"position":91,"is_corresponding":false},{"id":1365592,"name":"Rosario Sánchez","orcid":null,"position":92,"is_corresponding":false},{"id":1364723,"name":"John Delgado","orcid":"0000-0002-2055-7442","position":93,"is_corresponding":false},{"id":1365593,"name":"Kari Jaasko","orcid":null,"position":94,"is_corresponding":false},{"id":801049,"name":"Stanley H. Hsia","orcid":"0000-0003-0945-321X","position":95,"is_corresponding":false},{"id":1365594,"name":"Cecilia Rodríguez","orcid":null,"position":96,"is_corresponding":false},{"id":392712,"name":"David Guzman","orcid":"0000-0003-4206-8890","position":97,"is_corresponding":false},{"id":1365595,"name":"Lourdes Garibay","orcid":null,"position":98,"is_corresponding":false},{"id":1365596,"name":"Margaret Chang","orcid":null,"position":99,"is_corresponding":false},{"id":34495,"name":"John B. Buse","orcid":"0000-0002-9723-3876","position":0,"is_corresponding":true}],"reference_count":36,"raw_metadata":null,"created_at":"2026-07-19T02:47:30.942539Z","pmid":"40249765","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}