China: A recent study conducted by the Sleep Apnea and Hypertension cohort has found a potential link between diurnal cortisol features and the risk of incident Type 2 diabetes (T2D) in patients with hypertension and obstructive sleep apnea (OSA), published in the Journal of Clinical Endocrinology & Metabolism.

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The hypothalamic-pituitary-adrenal (HPA) axis, which plays a crucial role in regulating the body's stress response, has long been associated with T2D. The study aimed to investigate whether HPA axis dysfunction is specifically associated with incident T2D in patients with hypertension and OSA.

The study involved 1478 patients with hypertension and OSA who underwent a cortisol rhythm test at baseline. A Cox regression model was used to evaluate the relationship between ln-transformed diurnal cortisol features and T2D risk. During a median follow-up of 7.0 years, 196 participants developed T2D.
The study concluded with the following clinical findings:
1. 196 participants developed T2D during the study.
2. Steep diurnal cortisol slope (DCS) was associated with decreased T2D risk.
3. Midnight cortisol was associated with increased T2D risk.
4. DCS and midnight cortisol were not associated with incident T2D in the women’s subgroup or participants with mild OSA.
The study suggests that diurnal cortisol features may serve as an early prevention target for diabetes in patients with hypertension and OSA, particularly for men or those with moderate to severe OSA. The findings may have implications for the development of new prevention strategies and interventions for T2D in this population.
The researchers added that “The study sheds light on the complex relationship between the HPA axis, diurnal cortisol features, and T2D risk in patients with hypertension and OSA. Further research is needed to confirm these findings and explore the underlying mechanisms.”
Reference:
Gan L., Li N., Heizhati M., Li M., Yao L., Hong J., Wu T., Wang H., Liu M., Maitituersun A., Diurnal Cortisol Features and Type 2 Diabetes Risk in Patients With Hypertension and Obstructive Sleep Apnea: A Cohort Study, The Journal of Clinical Endocrinology & Metabolism, 2023; dgad184, https://doi.org/10.1210/clinem/dgad184