Cortisol Secretion Correlates With Diabetic Complications

Cortisol secretion is elevated in type 2 diabetics with chronic complications. Some previous studies have shown elevations of ACTH in patients with type 2 diabetes, the authors explain, whereas others have shown no alteration in hypothalamic-pituitary-adrenal (HPA) axis activity.

Dr. Iacopo Chiodini from University of Milan, Italy and colleagues evaluated the HPA activity in a sample of 170 type 2 diabetic patients with or without chronic complications and in a sample of 71 nondiabetic controls matched for sex, age and BMI.
Overall, the patients with type 2 diabetes had higher levels of urinary free cortisol; serum cortisol after a 1-mg overnight dexamethasone suppression test; 12:00 p.m. serum cortisol; and hypertension than did the control group, the authors report.
Among diabetic patients, those with chronic complications had higher parameters of HPA axis function than did those without chronic complications, the results indicate.

HPA axis function did not correlate with A1c, disease duration, waist circumference, insulin resistance, or number of components of the metabolic syndrome, the researchers note.

The number of diabetic complications, however, was significantly associated with 12:00 p.m. serum cortisol level and with diabetes duration, the report indicates.

Serum cortisol level at 12:00 p.m. was significantly related to retinopathy and neuropathy, the investigators say, but other parameters of the HPA axis were not individually associated with the presence of any diabetes complication.

Dr. Chiodini stated that, "Even if these findings have no immediate implications for the clinical management of these patients, further studies are needed to find out if HPA axis activity has a causative role in determining chronic complications of type 2 diabetes."

"A good idea may be to evaluate the effects of rosiglitazone on pituitary-adrenal activity in diabetic patients with and without complications, given the role of this molecule in both adrenal activity and insulin resistance," Dr. Chiodini added.
Diabetes Care 2007;30:83-88.

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