Recently, Mifepristone, a drug used to treat multiple conditions, came under fire in the U.S. Supreme Court. One indication for this medication is in specific cases of Type 2 Diabetes, the most common form of diabetes in the United States. Comprising 90-95% of all diabetes patients it most often occurs in individuals over 45. Appropriate treatment for any given individual is specific and benefits from numerous medical intervention options.

While currently in the news for its other uses, Mifepristone is a valuable medication for treating insulin resistance in specific patient populations. Insulin resistance is commonly associated with Type 2 diabetes, presenting an increase in blood glucose levels, also known as hyperglycemia. Increased glucose levels damage the eyes, nerves, kidneys, and heart, with damage gradually worsening over time. Prolonged insufficient insulin absorption can lead to diabetic ketoacidosis: a deadly condition where the blood pH is too acidic, which can result in coma and death.

Cushing’s Syndrome and Diabetes

Poor glycemic control and insulin resistance can be caused by the body releasing too much insulin or prolonged high cortisol levels, such as with Cushing’s Syndrome. 1 in 4 diabetes patients who have Type 2 Diabetes also have Cushing’s Syndrome. In the event of Cushing’s Syndrome, individuals’ adrenal glands produce an excess of the hormone, cortisol. Cushing’s Syndrome chronically elevates cortisol levels, contributing to insulin resistance. Additional medical problems that can arise include decreases in immune function, weight gain, fatigue, vision loss, and more. If a patient is concerned that they may have Cushing’s Syndrome they should contact their doctor.

Mifepristone blocks cortisol from binding to the glucocorticoid receptor on cells, reducing insulin resistance and aiding in better glycemic control. In the event of Type 2 Diabetes resulting from Cushing’s Syndrome, Mifepristone is the only FDA-approved option for both men and women, making it a vital resource for endocrinologists and their patients. Mifepristone is an option prescribed for a particular combination of circumstances and may not be appropriate in other cases. A patient should work with their endocrinologist and primary care physician to determine the treatment options best for them. That is why multiple treatment options are necessary.

During a time of ongoing diabetes medication shortages, the potential loss of this sole medical option for some patients could have devastating impacts. Therefore, as the United States debates the FDA approval status of Mifepristone, individuals need to consider potential unintended consequences for middle-aged and older populations using it to treat Type 2 Diabetes.