Applying the Results of the CATALYST Study to Clinical Practice

Video content above is prompted by the following:

The CATALYST study findings have profound implications for clinical practice, particularly in identifying and treating patients with treatment-resistant diabetes. The study population represented truly difficult-to-control diabetes cases, with patients already optimized on multiple advanced therapies including glucagon-like peptide-1 receptor (GLP-1) agonists, SGLT2 inhibitors, and insulin regimens. Despite being on state-of-the-art diabetes medications, these patients had inadequate control, emphasizing that this represents a distinct population requiring different therapeutic approaches beyond traditional diabetes management.

Clinical practitioners highlighted that patients failing to respond to GLP-1 receptor agonists and SGLT2 inhibitors should trigger consideration of hypercortisolism screening. The study results validate what many clinicians observe in practice: Certain patients remain with persistent uncontrolled disease despite optimal medical management and good adherence. These patients often feel frustrated and view themselves as failures, making the identification of an underlying, treatable cause particularly impactful for their psychological well-being and treatment engagement.

The approach represents true precision medicine in diabetes care, moving beyond the “give it to everyone” mentality of many diabetes drugs to a targeted, test-based treatment strategy. This paradigm shift involves screening patients who meet specific criteria (multiple diabetes medications, multiple antihypertensive agents) and treating only those with confirmed hypercortisolism. The psychological benefits extend beyond glycemic control, as many patients experience improvements in depression, cognitive function, and overall quality of life, addressing the broader systemic effects of excess cortisol that often go unrecognized in clinical practice.