High Cortisol Levels Linked to Stubborn Type 2 Diabetes Cases

New research suggests that high cortisol levels may play a key role in treatment-resistant type 2 diabetes. A recent trial found that nearly a quarter of patients struggling to control their condition had hypercortisolism. Experts now recommend screening for this hormone imbalance in those not responding to standard therapies.

The findings come from studies led by Corcept Therapeutics, a company specialising in cortisol-modulating treatments. Their drug Korlym, when combined with GLP-1 medications or tirzepatide, showed significant improvements in blood sugar control and weight loss. The CATALYST trial revealed that 24% of patients with hard-to-manage type 2 diabetes had elevated cortisol levels. Among those with both resistant hypertension and diabetes, the figure rose to 36.6%. A separate trial, MOMENTUM, found a similar pattern, with 32.6% of patients in this group showing hypercortisolism.

Patients treated with Korlym in the CATALYST study saw a notable drop in HbA1c levels—an average reduction of 1.3% compared to placebo. Those already on GLP-1 drugs or tirzepatide experienced even greater benefits, including lower body weight, BMI, and waist circumference. On average, Korlym users lost 5.1 kg, reduced their BMI by 1.7 kg/m², and trimmed 5.1 cm from their waist.

Dr. Lance Sloan, President of the Texas Institute for Kidney and Endocrine Disorders, emphasised the importance of these findings. He stated that identifying and treating hypercortisolism could be crucial for patients who fail to improve with standard diabetes treatments. The data suggest cortisol may be a hidden factor in treatment-resistant cardiometabolic diseases, even when patients receive advanced therapies like GLP-1 agonists.

Corcept Therapeutics focuses on developing medications that target cortisol-related disorders. Their research highlights how modulating cortisol might enhance the effects of existing diabetes drugs, offering a new approach for difficult cases. The trials indicate that Korlym, when added to GLP-1 or tirzepatide treatment, can lead to better blood sugar control and weight management. With hypercortisolism affecting a significant portion of resistant diabetes cases, screening for cortisol imbalances may become a standard step in care. These results could change how clinicians approach patients who struggle to respond to conventional therapies.