Could Undiagnosed Hormone Imbalance Be a Hidden Factor in Difficult-to-Control Diabetes?
For many individuals with type 2 diabetes (T2D) who struggle to manage their blood sugar despite multiple medications, an often-overlooked condition – hypercortisolism – may be a contributing factor, according to a recent study.
Researchers have found that approximately one-quarter of those with T2D that remains poorly controlled, even with the use of newer antidiabetic drugs, could have underlying hypercortisolism, a condition characterized by elevated levels of the hormone cortisol. This suggests that addressing this hormonal imbalance could improve glycemic control in some patients.
The prospective observational study, known as Catalyst, evaluated 1,057 individuals with T2D who had HbA1c levels between 7.5% and 11.5% (58 to 102 mmol/mol) despite being on two or more hypoglycemic medications. Participants as well had varying degrees of micro- or macrovascular complications.
All patients underwent a standard dexamethasone suppression test (DST) to assess cortisol levels. Researchers carefully excluded common causes of false positives in the test. The primary outcome measured was the prevalence of hypercortisolism, defined as a post-test cortisol level exceeding 1.8 µg/dL (50 nmol/L).
The study revealed that cortisol levels were not suppressed in 23.8% [21.3-26.5] (n = 252) of the patients. Notably, hypercortisolism was observed in 33.3% of those with heart problems and 36.6% of those taking three or more antihypertensive medications. Imaging revealed adrenal abnormalities in 34.7% of participants with hypercortisolism.
These findings, published on April 3, 2026, highlight the importance of considering hypercortisolism in patients with T2D who are not responding adequately to standard treatments. Early detection and management of this condition could potentially improve outcomes for a significant number of individuals living with diabetes.
Even as the effects of glucocorticoids on glucose metabolism are similar, managing diabetes in these two forms of the condition requires specific approaches, relying on antidiabetic treatments and, when possible, correcting the hypercortisolism or discontinuing glucocorticoid use.
Some cases of difficult-to-manage type 2 diabetes may be linked to hypercortisolism, which appears to be more prevalent than previously known, and fortunately, diagnostic and treatment tools are readily available.
