Abstract
Diabetic nephropathy (DN) is one of the leading causes of chronic kidney disease and end-stage renal failure in patients with Type 2 Diabetes Mellitus (T2DM). This study evaluated the relationship between fasting serum cortisol levels and the severity of nephropathy and glycemic control in T2DM patients. A cross-sectional observational study was conducted over 18 months at a tertiary care center in Northern India. Among 500 screened patients, 100 individuals with T2DM and nephropathy (urinary albumin-creatinine ratio [UACR] ≥30 mg/g) were enrolled. Early morning fasting serum cortisol levels were measured using chemiluminescence immunoassay. Statistical analysis was performed using SPSS version 26. The mean age of participants was 60.7±11.25 years and 93% had diabetes for more than five years. Serum cortisol levels were significantly higher in patients with poor glycemic control (HbA1c >10%) compared with those having HbA1c 6.5–8% (24.05±3.43 vs. 22.46±2.12 µg/dL; p=0.019). Patients with macroalbuminuria showed significantly higher cortisol levels than those with microalbuminuria (24.45±3.02 vs. 21.47±1.84 µg/dL; p=0.001). Cortisol demonstrated positive correlations with UACR (r=0.425), diabetes duration (r=0.412) and HbA1c (r=0.385) (all p<0.001). Higher cortisol levels were also associated with diabetic retinopathy and neuropathy. Elevated serum cortisol levels are associated with poor glycemic control, increasing albuminuria and microvascular complications in T2DM. Serum cortisol may serve as a useful biomarker for identifying patients at risk of progressive diabetic nephropathy.
Keywords: Albuminuria, Diabetic Nephropathy, Glycemic Control, Serum Cortisol, Type 2 Diabetes Mellitus.