切换至 "中华医学电子期刊资源库"

中华诊断学电子杂志 ›› 2026, Vol. 14 ›› Issue (01) : 66 -70. doi: 10.3877/cma.j.issn.2095-655X.2026.01.010

综述

皮质醇水平与节律在2型糖尿病及其并发症中的研究进展
苏克敏1, 孙静1, 杨烁1, 李艳英2, 张梅2, 刘福朋2,()   
  1. 1272013 济宁医学院临床医学院
    2272029 济宁医学院附属医院内分泌遗传代谢科
  • 收稿日期:2025-12-15 出版日期:2026-02-26
  • 通信作者: 刘福朋
  • 基金资助:
    国家卫生健康委能力建设和继续教育中心慢病管理研究(GWJJMB202510024030)

Research progress on cortisol levels and rhythm in type 2 diabetes mellitus and its complications

Kemin Su1, Jing Sun1, Shuo Yang1, Yanying Li2, Mei Zhang2, Fupeng Liu2,()   

  1. 1College of Clinical Medicine, Jining Medical University, Jining 272013, China
    2Department of Endocrinology and Genetic Metabolism, the Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2025-12-15 Published:2026-02-26
  • Corresponding author: Fupeng Liu
引用本文:

苏克敏, 孙静, 杨烁, 李艳英, 张梅, 刘福朋. 皮质醇水平与节律在2型糖尿病及其并发症中的研究进展[J/OL]. 中华诊断学电子杂志, 2026, 14(01): 66-70.

Kemin Su, Jing Sun, Shuo Yang, Yanying Li, Mei Zhang, Fupeng Liu. Research progress on cortisol levels and rhythm in type 2 diabetes mellitus and its complications[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2026, 14(01): 66-70.

目前,2型糖尿病(T2DM)患病率持续攀升,其多系统并发症的防治已成为重大公共卫生挑战。除糖脂代谢异常等传统危险因素外,下丘脑-垂体-肾上腺轴功能失调所导致的皮质醇分泌水平异常及其昼夜节律紊乱,在T2DM及其并发症的发生发展中的作用日益受到关注。笔者系统梳理了皮质醇水平异常与节律紊乱对T2DM发病风险的临床证据,归纳了T2DM患者皮质醇水平及节律的典型改变特征,并重点阐述了二者与T2DM相关心脑血管病变、微血管病变,以及骨骼肌肉系统病变之间的关联,以期为深入揭示其机制,并探索将皮质醇水平及节律作为双重评估靶点的防治策略提供理论依据。

At present, the prevalence of type 2 diabetes mellitus (T2DM) continues to rise, and the prevention and treatment of its multi-system complications have become a major public health challenge. In addition to traditional risk factors such as abnormal glucose and lipid metabolism, abnormal cortisol secretion levels and rhythm disorders caused by hypothalamic-pituitary-adrenal axis dysfunction have increasingly attracted attention in the onset and progression of T2DM and its complications. The authors systematically review the clinical evidence on the impact of abnormal cortisol levels and rhythm disorders on the risk of T2DM, summarize the typical changes in cortisol levels and rhythms in T2DM patients, and focus on elaborating the associations between the two and the cerebrovascular diseases, microvascular diseases, and musculoskeletal system diseases related to T2DM, with the aim of providing a theoretical basis for deeply revealing its mechanism and exploring prevention and treatment strategies that take cortisol levels and rhythms as dual assessment targets.

[1]
Hamblin PSRussell AWTalic S,et al.The growing range of complications of diabetes mellitus[J].Trends Endocrinol Metab202536(10):943-954.DOI:10.1016/j.tem.2024.12.006.
[2]
Młynarska ECzarnik WDziez·a N,et al.Type 2 diabetes mellitus:new pathogenetic mechanisms,treatment and the most important complications[J].Int J Mol Sci202526(3):1094.DOI:10.3390/ijms26031094.
[3]
冉启玉,汤怀鹏,孔蕾,等.糖尿病视网膜病变中神经退行性变的发病机制及其潜在的治疗方法[J/CD].中华诊断学电子杂志202311(2):120-124.DOI:10.3877/cma.j.issn.2095-655X.2023.02.010.
[4]
Stalder T, Oster H, Abelson JL, et al. The cortisol awakening response:regulation and functional significance[J].Endocr Rev202546(1):43-59.DOI:10.1210/endrev/bnae024.
[5]
Lightman SLBirnie MTConway-Campbell BL.Dynamics of ACTH and cortisol secretion and implications for disease[J].Endocr Rev202041(3):bnaa002.DOI:10.1210/endrev/bnaa002.
[6]
Gan LLi NHeizhati M,et al.Diurnal cortisol features and type 2 diabetes risk in patients with hypertension and obstructive sleep apnea:a cohort study[J].J Clin Endocrinol Metab2023108(9):e679-e686.DOI:10.1210/clinem/dgad184.
[7]
Hackett RAKivimäki MKumari M,et al.Diurnal cortisol patterns,future diabetes,and impaired glucose metabolism in the Whitehall II cohort study[J].J Clin Endocrinol Metab2016101(2):619-625.DOI:10.1210/jc.2015-2853.
[8]
Ortiz RKluwe BOdei JB,et al.The association of morning serum cortisol with glucose metabolism and diabetes:the Jackson Heart Study[J].Psychoneuroendocrinology2019(103):25-32.DOI:10.1016/j.psyneuen.2018.12.237.
[9]
Hackett RASteptoe AKumari M.Association of diurnal patterns in salivary cortisol with type 2 diabetes in the Whitehall II study[J].J Clin Endocrinol Metab201499(12):4625-4631.DOI:10.1210/jc.2014-2459.
[10]
Buse JBKahn SEAroda VR,et al.Prevalence of hypercortisolism in difficult-to-control type 2 diabetes[J].Diabetes Care202548(12):2012-2020.DOI:10.2337/dc24-2841.
[11]
Defronzo RA.Banting Lecture.From the triumvirate to the ominous octet:a new paradigm for the treatment of type 2 diabetes mellitus[J].Diabetes200958(4):773-795.DOI:10.2337/db09-9028.
[12]
DeFronzo RAAuchus RJ.Cushing syndrome,hypercortisolism,and glucose homeostasis:a review[J].Diabetes202574(12):2168-2178.DOI:10.2337/db25-0120.
[13]
Brosolo G, Da PortoA, Bulfone L, et al. Cortisol secretion and abnormalities of glucose metabolism in nondiabetic patients with hypertension[J].J Hypertens202442(2):227-235.DOI:10.1097/HJH.0000000000003590.
[14]
Brox-Torrecilla NGarcía CanoAMValderrábano P,et al.Prevalence and incidence of type 2 diabetes mellitus in patients with adrenal incidentalomas:a study of 709 cases[J].Endocrine202381(3):484-491.DOI:10.1007/s12020-023-03396-6.
[15]
Elhassan YSAlahdab FPrete A,et al.Natural history of adrenal incidentalomas with and without mild autonomous cortisol excess:a systematic review and meta-analysis[J].Ann Intern Med2019171(2):107-116.DOI:10.7326/M18-3630.
[16]
Kluwe BOrtiz ROdei JB,et al.The association of cortisol curve features with incident diabetes among whites and African Americans:the CARDIA study[J].Psychoneuroendocrinology2021(123):105041.DOI:10.1016/j.psyneuen.2020.105041.
[17]
Seaton EKZeiders KH.Daily racial discrimination experiences,ethnic-racial identity,and diurnal cortisol patterns among Black adults[J].Cultur Divers Ethnic Minor Psychol202127(1):145-155.DOI:10.1037/cdp0000367.
[18]
Song M, Bai H, Zhang P, et al. Promising applications of human-derived saliva biomarker testing in clinical diagnostics[J].Int J Oral Sci202315(1):2.DOI:10.1038/s41368-022-00209-w.
[19]
Lederbogen FHummel JFademrecht C,et al.Flattened circadian cortisol rhythm in type 2 diabetes[J].Exp Clin Endocrinol Diabetes2011119(9):573-575.DOI:10.1055/s-0031-1275288.
[20]
Johar HEmeny RTBidlingmaier M,et al.Sex-related differences in the association of salivary cortisol levels and type 2 diabetes.Findings from the cross-sectional population based KORA-age study[J].Psychoneuroendocrinology2016(69):133-141.DOI:10.1016/j.psyneuen.2016.04.004.
[21]
Champaneri SXu XCarnethon MR,et al.Diurnal salivary cortisol and urinary catecholamines are associated with diabetes mellitus:the Multi-Ethnic Study of Atherosclerosis[J].Metabolism201261(7):986-995.DOI:10.1016/j.metabol.2011.11.006.
[22]
王怡丹.2型糖尿病患者皮质醇节律异常的相关因素分析[D].大连:大连医科大学,2020.
[23]
Incollingo RodriguezACEpel ESWhite ML,et al.Hypothalamic-pituitary-adrenal axis dysregulation and cortisol activity in obesity:a systematic review[J].Psychoneuroendocrinology2015(62):301-318.DOI:10.1016/j.psyneuen.2015.08.014.
[24]
Spanakis EKWang XSánchez BN,et al.Lack of significant association between type 2 diabetes mellitus with longitudinal change in diurnal salivary cortisol:the multiethnic study of atherosclerosis[J].Endocrine201653(1):227-239.DOI:10.1007/s12020-016-0887-8.
[25]
Liang YLiang JJiang W,et al.Stronger association between morning serum cortisol level and diurnal time in range in type 2 diabetes?[J].Diabetol Metab Syndr202416(1):290.DOI:10.1186/s13098-024-01515-5.
[26]
Mohd AzmiNJuliana NAzmani S,et al.Cortisol on circadian rhythm and its effect on cardiovascular system[J].Int J Environ Res Public Health202118(2).DOI:10.3390/ijerph18020676.
[27]
Boudreau PYeh WHDumont GA,et al.Circadian variation of heart rate variability across sleep stages[J].Sleep201336(12):1919-1928.DOI:10.5665/sleep.3230.
[28]
Karl SJohar HLadwig KH,et al.Dysregulated diurnal cortisol patterns are associated with cardiovascular mortality:findings from the KORA-F3 study[J].Psychoneuroendocrinology2022(141):105753.DOI:10.1016/j.psyneuen.2022.105753.
[29]
Reynolds RMLabad JStrachan MW,et al.Elevated fasting plasma cortisol is associated with ischemic heart disease and its risk factors in people with type 2 diabetes:the Edinburgh type 2 diabetes study[J].J Clin Endocrinol Metab201095(4):1602-1608.DOI:10.1210/jc.2009-2112.
[30]
Jin YWei DLiu P,et al.Serum cortisol,25 (OH)D,and cardiovascular risk factors in patients with type 2 diabetes mellitus[J].Int J Endocrinol2022(2022):5680170.DOI:10.1155/2022/5680170.
[31]
Chiodini IAdda GScillitani A,et al.Cortisol secretion in patients with type 2 diabetes:relationship with chronic complications[J].Diabetes Care200730(1):83-88.DOI:10.2337/dc06-1267.
[32]
Sun SWang Y.Relationship between cortisol and diabetic microvascular complications:a retrospective study[J].Eur J Med Res202328(1):391.DOI:10.1186/s40001-023-01325-x.
[33]
Zhang XDeng XZhou J,et al.The association of serum cortisol level with microalbuminuria in patients with type 2 diabetes and prediabetes[J].Int J Med Sci202017(18):2998-3004.DOI:10.7150/ijms.48742.
[34]
Li SLuo XLu Z,et al.Association of midnight cortisol level with bone mineral density in Chinese patients with type 2 diabetes mellitus:a cross-sectional study[J].Diabetes Metab Syndr Obes2024(17):2943-2953.DOI:10.2147/DMSO.S470391.
[35]
Liu F, Yang Q, Yang K, et al. Cortisol circadian rhythm and sarcopenia in patients with type 2 diabetes:a cross-sectional study[J].J Cachexia Sarcopenia Muscle202516(1):e13727.DOI:10.1002/jcsm.13727.
[36]
Isidori AMPofi RFleseriu M.Beyond the classical axis:metabolic " pressure" on the adrenal gland?[J].Diabetes202574(12):2207-2210.DOI:10.2337/dbi25-0035.
[37]
Clarke SA, Eng PC, Comninos AN, et al. Current challenges and future directions in the assessment of glucocorticoid status[J].Endocr Rev202445(6):795-817.DOI:10.1210/endrev/bnae016.
[38]
Tanoue AIto SHonda K,et al.The vasopressin V1b receptor critically regulates hypothalamic-pituitary-adrenal axis activity under both stress and resting conditions[J].J Clin Invest2004113(2):302-309.DOI:10.1172/JCI19656.
[39]
Gathercole LLLavery GGMorgan SA,et al.11β-hydroxysteroid dehydrogenase 1:translational and therapeutic aspects[J].Endocr Rev201334(4):525-555.DOI:10.1210/er.2012-1050.
[40]
Dendoncker KTimmermans SVandewalle J,et al.TNF-α inhibits glucocorticoid receptor-induced gene expression by reshaping the GR nuclear cofactor profile[J].Proc Natl Acad Sci U S A2019116(26):12942-12951.DOI:10.1073/pnas.1821565116.
[41]
Andreadi AAndreadi STodaro F,et al.Modified cortisol circadian rhythm:the hidden toll of night-shift work[J].Int J Mol Sci202526(5):2090.DOI:10.3390/ijms26052090.
[42]
Kim NKa SPark J.Effects of exercise timing and intensity on physiological circadian rhythm and sleep quality:a systematic review[J].Phys Act Nutr202327(3):52-63.DOI:10.20463/pan.2023.0029.
[43]
Paragliola RM, Marchetti M, Montagna C, et al. " Feeding the rhythm" -effects of food and nutrients on daily cortisol secretion:from molecular mechanisms to clinical impact[J].Int J Mol Sci202526(22):11230.DOI:10.3390/ijms262211230.
[44]
Rogerson OWilding SPrudenzi A,et al.Effectiveness of stress management interventions to change cortisol levels:a systematic review and meta-analysis[J].Psychoneuroendocrinology2024(159):106415.DOI:10.1016/j.psyneuen.2023.106415.
[45]
Luo CYu XMZeng MQ,et al.Breaking the diabetes-depression cycle:exploring shared mechanisms,neuroinflammation,and emerging interventions for metabolic-mood comorbidities[J].World J Diabetes202516(7):107406.DOI:10.4239/wjd.v16.i7.107406.
[46]
Rosenstock JBanarer SFonseca VA,et al.The 11-beta-hydroxysteroid dehydrogenase type 1 inhibitor INCB13739 improves hyperglycemia in patients with type 2 diabetes inadequately controlled by metformin monotherapy[J].Diabetes Care201033(7):1516-1522.DOI:10.2337/dc09-2315.
[47]
DeFronzo RAFonseca VAroda VR,et al.Inadequately controlled type 2 diabetes and hypercortisolism:improved glycemia with mifepristone treatment[J].Diabetes Care202548(12):2036-2044.DOI:10.2337/dc25-1055.
[1] 曹雯佳, 刘学兵, 罗安果, 钟释敏, 邓岚, 王玉琳, 李赵欢. 超声矢量血流成像对2型糖尿病患者颈动脉壁剪切应力的研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 709-717.
[2] 孟令凯, 李大勇, 王宁, 王桂明, 张炳南, 李若彤, 潘立峰. 袖状胃切除术对肥胖伴2型糖尿病大鼠的作用及机制研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 638-642.
[3] 李猛, 姜腊, 董磊, 吴情, 贾犇黎. 腹腔镜胃袖状切除术治疗肥胖合并2型糖尿病及脂肪胰的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 554-557.
[4] 汤乘, 瞿根义, 阳光, 徐勇, 江伟民. 基于GWAS数据库的2型糖尿病与勃起功能障碍两样本孟德尔随机化分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(01): 71-76.
[5] 赵小民, 杨军, 田巍巍. 枳术颗粒联合利那洛肽治疗便秘型肠易激综合征的临床研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 465-469.
[6] 秦楠, 汪川, 穆尼热·穆合塔尔, 蒋升. 2 型糖尿病患者维生素D 与胰岛功能的相关性[J/OL]. 中华临床医师杂志(电子版), 2025, 19(03): 199-205.
[7] 王璇, 娜扎开提·尼加提, 雒洋洋, 蒋升. 皮肤晚期糖基化终末产物浓度与2型糖尿病微血管并发症的相关性[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 447-454.
[8] 操龙斌, 卢远思, 邱欣, 叶琪. 2型糖尿病患者全血细胞计数衍生的炎症指数与下肢动脉粥样硬化病变的关系[J/OL]. 中华临床实验室管理电子杂志, 2025, 13(03): 159-165.
[9] 闫文貌, 白日星. 两例改良单吻合口胃旁路术病例报道[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(04): 344-347.
[10] 林小灵, 刘恬宁, 艾星星, 黄洁微, 袁香华, 赵宛鄂, 刘雪彦. 新诊断2型糖尿病患者颈动脉病变与血脂、脉压、肱踝指数的相关性的研究[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(04): 276-281.
[11] 李振振, 刘震东, 钱昊, 许语阳, 戚悠飞, 肖占祥, 刘敏. 下肢动脉硬化闭塞症与代谢性疾病的相关性研究[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(02): 111-120.
[12] 王国峰, 吕舒, 肖金潭, 刘国力, 刘伯芹. 体重变异性与泛血管疾病关系的研究进展[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(02): 135-141.
[13] 宋宇佳, 孟化. 基于营养刺激激素受体靶点新型减重药物的临床研究现状与进展[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(01): 33-39.
[14] 门航, 厉周, 韩帅. 肥胖与2 型糖尿病研究进展[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(01): 62-69.
[15] 邓垚, 谢壁成, 吴边, 兰丹凤. 减重手术对肠道菌群及代谢性炎症综合征影响的研究进展[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(01): 70-75.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?