Checking for Excess Cortisol in People With Hard-to-Control Type 2 Diabetes
Checks for high cortisol with a dexamethasone test in adults with hard-to-control diabetes.
Plain-language title generated from the registry record
Registry title: Prevalence and Predictors of Hypercorticolism in Patients With Difficult to Control Type 2 Diabetes Mellitus
Key facts
- Where
- Asyut, EgyptSee the site
Could this be for you?
Answer for yourself. This is not a decision: only the study team can say whether you can take part.
- Are you between 18 and 70 years old?
Source: NCT07873320, who can take part
Where in Egypt
- Assiut University hospitalAsyut, EgyptNo longer taking part
Questions to ask the study team
- How often do I need to come in, and for how long each time?
- Are travel costs paid?
- Can I keep my own doctor?
- What happens if I want to stop?
Trial details
- Who runs it
- Assiut University
- Trial code
- NCT07873320
- Record updated
- 14 October 2026
- Original description
Type 2 diabetes mellitus (T2DM) is a major global health burden, affecting approximately 589 million adults worldwide in 2024, with the number projected to reach 853 million by 2050 .Despite advances in glucose-lowering therapy, a substantial proportion of patients remain inadequately controlled despite multiple medications .Read full original descriptionShow less
Prevalence and Predictors of Hypercorticolism in Patients With Difficult to Control Type 2 Diabetes Mellitus
Type 2 diabetes mellitus (T2DM) is a major global health burden, affecting approximately 589 million adults worldwide in 2024, with the number projected to reach 853 million by 2050 .Despite advances in glucose-lowering therapy, a substantial proportion of patients remain inadequately controlled despite multiple medications .
Hypercortisolism is a potentially reversible contributor to poor glycemic control. Excess cortisol promotes hepatic gluconeogenesis, impairs peripheral insulin sensitivity, and adversely affects β-cell function, thereby contributing to insulin resistance and hyperglycemia .Clinical manifestations of Cushing syndrome may overlap with common features of T2DM and obesity, making mild or clinically unapparent hypercortisolism difficult to recognize .
Recent evidence has highlighted the relevance of hypercortisolism in patients with difficult-to-control T2DM. In the multicenter CATALYST study, 23.8% of 1,057 participants with inadequately controlled T2DM had an abnormal 1-mg dexamethasone suppression test (DST), defined as post-DST cortisol >1.8 µg/dL (50 nmol/L) . However, data regarding the prevalence and clinical characteristics of hypercortisolism among Egyptian patients with difficult-to-control T2DM are lacking.
The Endocrine Society recommends biochemical testing for suspected Cushing syndrome using validated first-line tests, including the 1-mg overnight DST, late-night salivary cortisol, or urinary free cortisol .Therefore, determining the prevalence and characteristics of hypercortisolism in difficult-to-control T2DM may help identify a potentially treatable contributor to persistent hyperglycemia and provide locally relevant evidence for clinical practice.
Inclusion: - Age: Adults ≥18 years and ≤70 years; - Diagnosis: Confirmed Type 2 Diabetes Mellitus ≥2 years duration according to ADA criteria; 3- Definition of Difficult-to-Control T2DM: HbA1c ≥8.5% on two separate measurements ≥3 months apart, despite adherence to ≥3 antidiabetic medications including basal insulin ≥0.5 IU/kg/day for a minimum of 6 months; 4- Treatment adherence: Confirmed medication adherence and proper insulin injection technique by clinical assessment + pharmacy refill records 5- Willingness: Signed informed consent to participate in the study and undergo 1mg DST + confirmatory tests.
Exclusion: Current or recent use <3 months of systemic glucocorticoids, estrogens, oral contraceptives, or drugs affecting cortisol metabolism like ketoconazole, rifampin, phenytoin. Topical/inhaled steroids <500 mcg/day beclomethasone equivalent are allowed; Known diagnosis of Cushing's syndrome, adrenal tumor, or pituitary disease previously diagnosed; Type 1 DM or any other specific types of diabetes; Acute illness, infection, or hospitalization <1 month- cause stress hypercortisolism; Severe hepatic failure,Child-Pugh C, or severe renal failure, eGFR <30 ml/min/1.73m² - affect cortisol metabolism; Pregnancy or lactation- due to physiological hypercortisolism; Alcohol abuse* >3 units/day for males, >2 units/day for females; Inability to understand study procedures or give consent; Depression.