Original Article
Related risk factors of abnormal glucose metabolism in patients with Cushing′s disease
Xinhua Liu, Xiaoming Zhu, Min He, Qing Miao, Wei Wu, Boni Xiang, Zengyi Ma, Yongfei Wang, Yiming Li, Hongying Ye
Published 2019-07-27
Cite as Chin J Diabetes Mellitus, 2019, 11(7): 461-465. DOI: 10.3760/cma.j.issn.1674-5809.2019.07.004
Abstract
ObjectiveTo investigate the characteristics and related risk factors of abnormal glucose metabolism in patients with Cushing′s disease.
MethodsA total of 154 patients who were hospitalized for Cushing′s disease in the Department of Endocrinology, Huashan Hospital affiliated to Fudan University from January 1st, 2013 to December 31st, 2017 were enrolled in this study. A retrospective method was used to analyze the prevalence of abnormal glucose metabolism in patients with Cushing′s disease. Insulin sensitivity was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICK) and Matsuda insulin sensitivity index (ISI Matsuda). β-cell function was evaluated by insulinogenic index (IGI)/HOMA-IR and insulin secretion-sensitivity index-2 (ISSI2). Spearman correlation analysis was used to investigate the relationship between cortisol level and insulin sensitivity or β-cell function. Logistic regression was used to analyze the possible factors associated with diabetes in patients with Cushing′s disease.
Results(1) Of these 154 patients with Cushing′s disease, 96(62.3%) were diagnosed as diabetes (DM group), while 32(20.8%) had prediabetes (preDM group). All of the preDM patients were impaired glucose tolerance. (2) The β-cell function evaluated by IGI/HOMA-IR and ISSI2 were lower in DM group than those in patients with normal glucose tolerance (NGT group) or preDM group. The IGI/HOMA-IR of NGT group, preDM group and DM group were 9.02(5.56, 12.53), 6.54(4.97, 8.79), 1.64(0.95, 3.31), respectively (P<0.001). ISSI2 of the three groups were 30.43 (25.42, 38.63), 25.80 (20.87, 30.62), 11.90 (7.18, 16.62), respectively (P<0.001). (3) Logistic regression analysis showed that high blood cortisol level (OR=1.138, 95%CI: 1.070-1.211), high urinary cortisol level (OR=1.001,95%CI:1.001-1.002) and older age (OR=1.083, 95%CI:1.033-1.135) were risk factors of diabetes in patients with Cushing′s disease. (4) IGI/HOMA-IR was negatively correlated with blood cortisol level (00∶00) and 24 h urinary free cortisol level (r=-0.401,-0.260, respectively, all P<0.05). ISSI2 was negatively correlated with blood cortisol level (00∶00) and 24 h urinary free cortisol level (r=-0.397,-0.242, respectively, all P<0.05) too.
ConclusionIn patients with Cushing′s disease, higher blood cortisol level, higher urinary cortisol level and older age are risk factors for diabetes. Whether patients with Cushing′s disease develop diabetes is mainly associated with their β-cell function.
Key words:
Cushing syndrome; Glucose metabolism disorders; β-cell function; Insulin sensitivity
Contributor Information
Xinhua Liu
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
Xiaoming Zhu
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
Min He
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
Qing Miao
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
Wei Wu
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
Boni Xiang
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
Zengyi Ma
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
Yongfei Wang
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
Yiming Li
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
Hongying Ye
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai 200040, China
