geoffrey modest medical blogs

  A recent article explored the relationship between difficult-to-control diabetes and endogenous hypercortisolism, finding improved glycemic control with the use of mifepristone   in the CATALYST study (see   dm hypercortisolism mifepristone rx DiabCare2025  in dropbox, or   https://doi.org/10.2337/dc25-1055 ), in the CATALYST study Details : -- 136 individuals who had type II diabetes (T2D) and hemoglobin A1c between 7.5% and 11.5% on multiple medications were then randomized in this prospective, multicenter, double-blind study of  the glucocorticoid receptor antagonist mifepristone (300 to 900 mg daily) vs placebo for 24 weeks, stratified by the presence or absence of an adrenal imaging abnormality     -- specifically, patients had to be on least three glucose lowering medications, or taking insulin and any other glucose lowering medication(s), or taking at least two glucose lowering medications and having at least one microvascular or mac...

    In patients with difficult-to-control type II diabetes, an impressive study found that about one quarter of them have hypercortisolism, and mifepristone improves their hyperglycemia (see dm hypercortisolism DiabCar2025  in dropbox or https://doi.org/10.2337/dc24-2841 ). thanks to Dr Elvira Isganaitis for bringing this to my attention.   Details : -- the CATALYST study enrolled 1063 participants with type II diabetes and a hemoglobin A1c ranging from 7.5%-11.5% and who were on two or more glucose lowering medications with or without micro/macro vascular complications or taking multiple blood pressure lowering medications -- these patients were screened with a 1 mg dexamethasone suppression test (DST)     -- common causes of false positives in DST evaluations were excluded, including taking oral contraceptives, excessive alcohol consumption, severe untreated sleep apnea, severe psych/medical/surgical illness, night shift work or hemodia...