How Doctors Can Be Better Educated About Cortisol Issues

GLP-1 medications might be most well-known as weight-loss options, but they were originally developed as a treatment for type 2 diabetes. For many patients, the drugs remain a highly effective treatment for the condition.

However, GLP-1s are not perfect and don’t work for every patient. In April of this year, Pharmaceutical Executive spoke with Mark Bagnall, CEO of Phenomix, discussed various reasons why a significant number of patients go off the medication within the first year of using it. His discussion focused on how side effects can be severe and incapitating, while the results can be inconsistent.

Pharmaceutical Executive recently spoke with Dr. Elena Christofides, scientific/medical advisor for Sparrow Pharmaceuticals, about a different issue some GLP-1 users face. Specifically, patients with high cortisol levels face unique challenges that GLP-1s may not be able to tackle.

Pharmaceutical Executive: How can doctors be better educated about cortisol issues?
Dr. Elena Christofides: We have been doing a significant amount of medical education — for physicians, nurse practitioners, PAs, and even patients — and the most important shift we need to make is getting providers to simply consider that cortisol may be part of the problem.

There is still a degree of blind spot in the medical community around this. Many providers believe that Cushing's syndrome or hypercortisolemia is too rare to be relevant to their practice, so it never enters the conversation. We need to change that starting point — with trainees, with new graduates, and with the providers delivering the bulk of diabetes care. The epidemiologic data shows this is not a small patient population. Cortisol dysregulation is more prevalent than the medical community currently assumes, and that assumption needs to be updated.

The practical implication is this: when a patient doesn't respond to their medications, the first thought should not be that the patient is non-adherent. The first thought should be that something has been missed — that there may be another diagnosis contributing to that patient's lack of response. Historically, the medical world has defaulted to a non-adherence assumption when medications don't work as expected. That framework needs to change. A patient who isn't getting to goal deserves a diagnostic workup, not a behavioral assumption.