An HbA1c benefit is only one part of a clinical decision. This Hormone Insight evidence review examines the randomized treatment phase of CATALYST: mifepristone in selected adults with difficult-to-control type 2 diabetes and biochemical hypercortisolism.

We review the population and trial design, the 24-week HbA1c and weight results, and findings on blood pressure, hypokalaemia, treatment discontinuation and serious adverse events. We also discuss missing data, secondary-endpoint multiplicity and why the result should not be generalized to everyone with type 2 diabetes.

For doctors and healthcare professionals. Learning objectives: identify the selected population; distinguish the primary HbA1c result from secondary findings; interpret efficacy alongside tolerability, safety and missing-data limitations; and recognize the difference between trial eligibility and the licensed indication.

Chapters

00:00 Benefit and treatment burden

00:23 The clinical question

00:47 Cortisol biology

01:10 Two study phases

01:26 The selected population

02:07 Intervention and comparator

02:40 Endpoints and design

03:13 HbA1c results

04:06 Weight results

04:31 Secondary-endpoint interpretation

04:57 Blood pressure

05:16 Hypokalaemia

05:53 Treatment discontinuation

06:25 Serious adverse events

06:59 Euglycaemic ketoacidosis

07:33 Adrenal insufficiency precautions

07:54 Missing data and appraisal

08:50 Long-term outcomes

09:06 Clinical applicability

09:45 Bottom line

10:23 Sources and scope

Primary paper: DeFronzo et al. Diabetes Care. 2025;48(12):2036–2044. DOI: 10.2337/dc25-1055.

PubMed: https://pubmed.ncbi.nlm.nih.gov/40550011/

Full text: https://pmc.ncbi.nlm.nih.gov/articles/PMC12635952/

Korlym prescribing information: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=542f3fae-8bc8-4f00-9228-e4b66c9ad6a9

Educational evidence appraisal, not patient-specific advice or a prescribing protocol. No CME accreditation is claimed. Narration is AI-generated using the Fahad voice. Study findings and prescribing information are distinct; consult current local product information before prescribing.