Prevalence in T2D

IN A RECENT STUDY OF 1057 PATIENTS WITH DIFFICULT-TO-CONTROL TYPE 2 DIABETES (T2D), 24% WERE DIAGNOSED WITH ENDOGENOUS HYPERCORTISOLISM1*

CATALYST—the largest US prospective clinical trial ever conducted to investigate the prevalence of endogenous hypercortisolism—revealed that nearly 1 in 4 patients with difficult-to-control T2D had endogenous hypercortisolism.2

Difficult-to-control T2D was defined as patients having an HbA1c of 7.5% - 11.5% and taking2:

  • ≥3 T2D medications OR

  • Insulin and other T2D medication(s) OR

  • ≥2 T2D medications AND

    • The presence of ≥1 microvascular or macrovascular complications AND/OR

    • Diagnosis of hypertension requiring ≥2 medications

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Twenty-four percent (two-hundred-fifty-two out of one-thousand-fifty-seven).

Nearly 1 in 4 (24%) of patients with difficult-to-control T2D had endogenous hypercortisolism1

Endogenous hypercortisolism was defined as1,2:

  • Post 1-mg DST cortisol >1.8 μg/dL

  • Confirmed AM dexamethasone level ≥140 ng/dL

A post 1-mg DST cortisol level >1.8 µg/dL is indicative of hypercortisolism. An AM serum dexamethasone level ≥140 ng/dL is sufficient to suppress cortisol in healthy individuals and confirms the test was performed correctly.

Patients with hypercortisolism often do not present with obvious physical features3

<0.1%

OF PATIENTS WITH ACTH-INDEPENDENT/ADRENAL HYPERCORTISOLISM DEVELOPED OBVIOUS PHYSICAL FEATURES

In a systematic review and meta-analysis of 32 studies reporting outcomes from 4121 patients, less than 0.1% of patients with autonomous cortisol secretion developed these features after >4 years of follow-up, though hypertension (60.0% of patients), obesity (42.0%), dyslipidemia (33.7%), and T2D (18.1%) were highly prevalent and more likely to develop and worsen in MACE than NFAT.3

ACTH-independent, adrenocorticotropic hormone-independent; MACE, mild autonomous cortisol excess; NFAT, non-functioning adrenal tumor.

CATALYST was a phase 4, two-part, multicenter trial. Part one (screening phase) primary endpoint was to determine the prevalence of hypercortisolism in patients with difficult-to-control type 2 diabetes (N=1057). Participants were screened with a 1-mg DST. Hypercortisolism defined as cortisol >1.8 μg/dL with dexamethasone ≥140 ng/dL.1,2

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References

1. Buse JB, Kahn SE, Aroda VR, et al. Diabetes Care. 2025;48(00):1-9. doi:10.2337/dc24-2841 2. DeFronzo RA, Auchus RJ, Bancos I, et al. BMJ Open. 2024;14(7):e081121. doi:10.1136/bmjopen-2023-081121 3. Elhassan YS, Alahdab F, Prete A, et al. Ann Intern Med. 2019;171(2):107-116. doi:10.7326/M18-3630 4. Petramala L, Olmati F, Concistrè A, et al. Endocrine. 2020;70(1):150-163. doi:10.1007/s12020-020-02297-2 5. Nieman LK, Biller BM, Findling JW, et al. J Clin Endocrinol Metab. 2008;93(5):1526-1540. doi:10.1210/jc.2008-0125 6. Ciftel S, Mercantepe F. Cureus. 2023;15(11):e48383. doi:10.7759/cureus.48383 7. Giovanelli L, Aresta C, Favero V, et al. J Endocrinol Invest. 2021;44(8):1581-1596. doi:10.1007/s40618-020-01484-2 8. Aresta C, Soranna D, Giovanelli L, et al. Endocr Pract. 2021;27(12):1216-1224. doi:10.1016/j.eprac.2021.07.014