Clinical Analysis Of Serum Cortisol And ACTH In Patients With Type 2 Diabetes Mellitus In Relation To Development Of Insulin Resistance

Objective1.To evaluate the abnormalities of serum cortisol and ACTH in patients with Type 2 Diabetes Mellitus of different stature.2.To evaluate the abnormalities of serum cortisol and ACTH in relation to development of insulin resistance.MethodsFifty T2DM subjects were grouped to patients with abdominal obesity and patients without abdominal obesity according to their Waist circumference(WC),Hip circumference(HC),waist-to-hip ratio(WHR),body mass index(BMI),serum cortisol and ACTH at 8am and 4pm,fasting plasma glucose(FPG),GHbA1c,insulin,and some other related index were measured in the subjects.HOMA-insulin resistance was calculated from the formula IR=fasting blood sugar×fasting insulin/22.5.To compare the difference of serum cortisol and ACTH among the groups and the abnormalities of serum cortisol and ACTH in relation to development of insulin resistance.Results1.Patients without abdominal obesity displayed higher plasma cortisol concentrations and higher plasma ACTH compared to normal control.The higher plasma cortisol concentrations was positively associated with FPG,GHbA1c,FINS and HOMA-IR.Further analysis revealed that HOMA-IR is the strongest factor associated with serum cortisol.2.In patients with abdominal obesity,both cortisol and ACTH concentrations are higher than normal control,and the ACTH concentrations are higher than the ACTH concentrations in the patients without abdominal obesity.The high level of cortisol was positively associated with hyperglycemia,and the high level of ACTH was positively associated with insulin resistance.3.All the patients of T2DM display abnormal circadian rhythms of cortisol and ACTH secretion.ConclusionsAll the patients of T2DM display abnormal circadian rhythms of cortisol and ACTH secretion.Patients with or without abdominal obesity displayed higher serum cortisol concentrations and higher serum ACTH compared to normal control,and the high level of cortisol and ACTH was closely associated with hyperglycemia and insulin resistance.