Hypercortisolism in Type 2 Diabetes with Treatment-Resistant Hyperglycemia: A Treatable Metabolic Phenotype?

Abstract

The primary goal of diabetes treatment is to prevent diabetes-related complications and improve long-term outcomes, and appropriate glycemic control remains central to this aim [1]. In recent years, diabetes management has placed greater emphasis on individualized treatment strategies, including the selection of glucose-lowering agents according to comorbidities and the adjustment of glycemic targets based on patient characteristics [1,2]. Nevertheless, for most adults with type 2 diabetes who do not have severe comorbidities or substantial hypoglycemia risk, a glycated hemoglobin (HbA1c) target of < 7.0%, or more strin-gently < 6.5%, remains a commonly used therapeutic goal [1]. Globally, an estimated 589 million adults, corresponding to approximately 11.1% of the adult population, are living with diabetes [3]. However, many patients still do not achieve recommended glycemic targets [4]. This treatment gap is also evident in the Republic of Korea. In a nationwide population-based study using data from the National Health Insurance Service, 60.6% of Korean patients with diabetes achieved HbA1c < 7.0%, leaving approximately 40% above this target. In addition, HbA1c ≥ 8.0% was observed in 16% of patients [5], indicating that many patients have poor glycemic control and may require more intensive evaluation and treatment strategies. This glycemic treatment gap is unlikely to have a single cause. Behavioral