ORLANDO, Florida — Almost a quarter of patients with poorly controlled type 2 diabetes enrolled in the prevalence-phase of a new study had hypercortisolism, suggesting there may need to be a shift in managing these individuals, said investigators.
If that incidence was extrapolated,"we're talking more than a million people in the United States, theoretically have this condition, just from poorly controlled diabetes," Buse said at the briefing. Buse said he and other investigators"are sort of holding off on pushing the American Diabetes Association to say, everybody with inadequately controlled diabetes, despite good faith efforts — two, three drugs — really should be treated for hypercortisolism."
To ensure the exclusion of those with falsely elevated cortisol, the trial did not enroll patients using oral contraceptives, or anyone with excess alcohol consumption, severe psychiatric illness or severe untreated sleep apnea, type 1 diabetes, or night shift work. The likelihood of having the condition also went up with overall medication burden. Those taking any cardiovascular medication, including antihypertensives, lipid medications, psychiatric drugs, and analgesics and opioids, all had a higher risk, said Fonseca.
Glucocorticoid antagonists have the potential to cause adrenal insufficiency, which can be dangerous and even can cause death, said Nieman."I would not change how I approach diabetic patients at this point," she said, adding that it's reasonable to look carefully for signs and symptoms of Cushing"in anybody who has difficult to control hypertension or diabetes."