Salivary Cortisol and Hypercortisolism in Type 2 Diabetes

Prior treatment

• A known diagnosis of Cushing's syndrome, or currently receiving treatment with any of the following: mifepristone, metyrapone, osilodrostat, ketoconazole, fluconazole, aminoglutethimide, etomidate, octreotide, larazotide, long-acting octreotide, or pasireotide.

Other illness

• Patients with Type 1 diabetes, new-onset diabetes (\<1 year duration), or other specific types of diabetes.
• History of systemic glucocorticoid use within the last 3 months (inhaled or topical agents are not exclusionary).
• Presence of severe cardiac, hepatic, renal, or other major organ dysfunction.
• History of acute diabetic complications, such as diabetic ketoacidosis or hyperosmolar hyperglycemic state, within the last 3 months.
• Presence of diseases that significantly affect metabolism, such as malignancy or autoimmune disorders.
• Inability to tolerate adhesive tape, severe skin conditions at the sensor placement site, or presence of a psychiatric illness or cognitive impairment that would interfere with study compliance.
• Known allergy or severe reaction to dexamethasone.

Other

• Pregnant or lactating.
• Excessive alcohol consumption (defined as \>14 units per week for males or \>7 units per week for females).
• Severe, untreated sleep apnea.
• Night shift workers (defined as being awake between 11:00 PM and 7:00 AM).

• Aged between 18 and 80 years.
• Meets the definition of difficult to control type 2 diabetes:
  • HbA1c level between 7.5% and 11.5%, AND Taking 3 or more anti-hyperglycemic drugs. OR Taking insulin and other anti-hyperglycemic drugs. OR Taking 2 or more anti-hyperglycemic drugs AND a.) the presence of 1 or more micro-vascular or macro-vascular complication (retinopathy, diabetic nephropathy and chronic kidney disease, diabetic neuropathy, atherosclerotic heart disease with diabetes); AND/OR b.) concomitant hypertension requiring 2 or more anti-hypertension medications.