Endocrine News Podcast · Endocrine Society

ENP110: Hypercortisolism and T2D

January 21, 2026·20 min

Aaron Lohr frames the episode around a practical question. He asks what healthcare providers should know about the relationship between type 2 diabetes and endogenous hypercortisolism when glucose remains difficult to control despite usual therapy. Dr. Vivian Fonseca and Dr. James Findling join to discuss the study. They are both authors of a Diabetes Care paper titled Inadequately Controlled Type 2 Diabetes and Hypercortisolism Improved Glycemia with Mifepristone Treatment, and the episode uses that work as the basis for a clinical conversation about hidden cortisol excess. The hosts start with definitions. For this study, the enrolled participants were adults between 18 and 80 years old with inadequately controlled diabetes, and the discussion focuses on how the investigators defined that group and why the cutoff mattered. The results then move into the patient mix. The group was about 60 years old on average, almost evenly split between men and women, and marked by moderate obesity and a broad cross-section of U.S. backgrounds. Their diabetes burden was substantial. The mean A1C was 8.8, many people were already taking three or more glucose-lowering drugs, and the regimen often included insulin, SGLT2 inhibitors, GLP-1 receptor agonists, dual agonists such as tirzepatide, or combinations of several of these agents. The episode also sketches the rest of their medication load. Many participants were on lipid-lowering therapy and antihypertensive medication, some were using analgesics, a small number were taking opioids, and a minority were on psychiatric medications, usually antidepressants rather than drugs for severe psychiatric disease. That background sets up the endocrine finding. The guests explain that 24 percent of the cohort had hypercortisolism, a prevalence that surprised them and stood out because the post-dexamethasone suppression test cortisol values were clearly elevated while the dexamethasone level suggested the test had been performed correctly. They also note the care taken to avoid false positives. The discussion says the team tried to exclude pseudo-Cushing's states, making the cortisol signal more notable rather than less. The clinical implication comes into focus from there. If a patient with diabetes remains difficult to control despite layered therapy, the episode suggests that cortisol excess may deserve consideration. The conversation stays practical about what that means for clinicians and patients. It ends by emphasizing that explaining the problem clearly can help patients accept what is going on and stay open to treatment solutions.

As heard by us

A focused look at why some type 2 diabetes stays hard to control.

Type 2 diabetes that stays hard to control gets a narrow endocrine lens here. The discussion follows what happens when glucose remains difficult to manage despite standard therapy, then asks whether endogenous hypercortisolism may be part of the picture.

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Why you'd press play

You want a practical read on diabetes that stays focused on what endocrinology providers need to know.

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