Dr. Elena Christofides highlights the role of cortisol dysregulation in influencing patient responses to incretin therapies, raising questions about personalised treatment approaches for type 2 diabetes.
GLP-1 drugs have become best known for weight loss, but they were first developed for type 2 diabetes and remain an important option for many patients. Yet, as Dr. Elena Christofides told Pharmaceutical Executive, the class does not deliver the same results for everyone, and one reason may be overlooked hormonal disruption, particularly elevated cortisol.
Christofides, a scientific and medical adviser to Sparrow Pharmaceuticals, said cortisol dysregulation can interfere with glucose signalling, insulin action and the body’s broader handling of fuel. In her view, that means some patients will not respond to incretin therapies, the drug group that includes GLP-1 medicines, as well as trial averages might suggest. She argued that this has implications not only for day-to-day care but also for how researchers design studies, since untreated cortisol problems could distort efficacy data.
She also said clinicians should be careful about which cortisol tests they rely on. Random cortisol and ACTH measurements, she said, are not suitable for screening. She pointed to the 24-hour urine free cortisol test as one originally built to detect pituitary disease, and salivary cortisol as a test with limited value for broad population screening. By contrast, she described the overnight dexamethasone suppression test as the most useful way to assess whether the hypothalamic-pituitary-adrenal axis is functioning properly.
Christofides said a poor response to GLP-1 therapy should prompt doctors to look beyond adherence and consider whether another diagnosis is affecting glucose control. She argued that cortisol-regulating treatment may help patients reach their targets when standard diabetes drugs appear to fall short. Her comments fit a wider debate in diabetes care, where clinicians are increasingly being urged to individualise treatment rather than rely only on average responses seen in clinical trials.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
