The Role of Hypercortisolism in Difficult-to-Control Type 2 Diabetes

In this episode, ‘The Role of Hypercortisolism in Difficult-to-Control Type 2 Diabetes,’ the panelists explore how the CATALYST trial has reshaped understanding of hypercortisolism in patients with difficult-to-control type 2 diabetes. They begin by reviewing the study design, including the inclusion and exclusion criteria, and explain why these details are essential for interpreting the trial results and applying them in everyday primary care practice.

The panel discusses the unexpectedly high prevalence of hypercortisolism identified among patients meeting the study criteria and reflects on how these findings challenge the longstanding perception that hypercortisolism is a rare condition. They examine which patient populations encountered in routine primary care may warrant greater clinical suspicion, particularly those requiring multiple glucose-lowering or antihypertensive medications or those with diabetes-related complications. The conversation also addresses why imaging alone cannot reliably identify all cases of hypercortisolism and why clinicians should not rely on adrenal abnormalities to exclude the diagnosis.

The panel of experts further considers the consequences of treating only the cardiometabolic comorbidities without recognizing the underlying endocrine disorder. They discuss how persistent cortisol excess contributes to ongoing cardiovascular risk, reduced quality of life, and continued patient frustration despite escalating therapy. Throughout the discussion, the panel emphasizes that identifying hypercortisolism represents an opportunity to look beyond routine diabetes management, reduce diagnostic delay, and improve patient outcomes through appropriate screening and endocrine evaluation.

The next episode in this series, ‘Hypercortisolism Screening in Primary Care,’ features the panelists discussing the practical use of the dexamethasone suppression test and comparing it with other screening approaches for hypercortisolism. They also share strategies for patient counseling and discuss factors that may influence accurate test interpretation.Welcome back to another Patient Care Online Peers and Perspectives series. In this episode titled, ‘Recognizing Hypercortisolism in Primary Care,’ expert faculty discuss the growing recognition of hypercortisolism as an underrecognized secondary cause of type 2 diabetes and the important role primary care clinicians play in identifying patients who may benefit from further endocrine evaluation. The panel explores how to recognize patients with difficult-to-control type 2 diabetes whose persistent hyperglycemia, hypertension, or multiple cardiometabolic comorbidities may signal an underlying endocrine disorder rather than routine disease progression.