Identifying Hypercortisolism in Patients with Resistant Diabetes

Hanford Yau, MD, Ralph DeFronzo, MD, Pam Kushner, MD, Honey East, MD, and Christopher Lucci, MD, explore resistant diabetes, share their clinical experience regarding the frequency of this condition, and highlight the role of continuous glucose monitoring in identifying patients who may be resistant, as indicated by prolonged periods of blood glucose levels outside the target range.

The expert panel addresses the common assumption of medication non-adherence in patients with resistant diabetes, provides strategies to differentiate non-adherence from underlying comorbidities contributing to resistance, and discusses the challenges of patients who are post-metabolic surgery, yet experience weight gain and symptom recurrence.

Medical experts underscore disparities in diabetes treatment access, stressing the impact of insurance plans on treatment decisions, which can hinder patients and providers, especially when considering newer medications like GLP-1 agonists.

Key Opinion Leaders address the psychiatric issues associated with hypercortisolism and highlight crucial clinical symptoms to look for when diagnosing the condition, such as hypertension in patients under 30 without a family history, diabetes in those under 40 with no family history, and bone issues among other signs.

Christopher Lucci, MD, reviews the current diagnostic tests for hypercortisolism, which include the Dexamethasone Suppression Test, DHEA level tests, and ACTH assessments.

The panel emphasizes the importance of early identification of patients based on subgroups, such as those with difficult-to-control diabetes, hypertension, and bone issues, highlighting that the inability to lower a patient's insulin dosage is a significant risk factor for hypercortisolism.

Ralph DeFronzo, MD, leads a discussion on the evolving perception of autonomous adrenal hypercortisolism, highlighting that its prevelance is significantly greater than previously understood.

Medical experts offer a comprehensive overview of the pathophysiology of hypercortisolism, detailing its impact on β-cell dysfunction and reduced insulin sensitivity, and discuss the potential role of GLP-1 treatment in managing the condition.

Panelists emphasize the importance of addressing underlying hypercortisolism, as it can lead to the development of osteoporosis and cardiovascular complications.

Panelists review current guidelines for treating hypercortisolism, noting the need for guidelines to align with recent advancements, and share their own clinical practice approaches.

Medical professionals discuss their ideal patients for surgery, and who would be best suited for pharmacologic intervention.

The panel concludes by discussing the long-term outcomes for patients treated for hypercortisolism, emphasizing the need for further studies and data, and sharing their final thoughts on the disease and its future management.