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Marijuana use tied to increased risk for diabetic ketoacidosis
Patients with type 1 diabetes who used marijuana had a higher risk for diabetic ketoacidosis compared with nonusers, according to data published in JAMA Internal Medicine.
“Cannabis use is increasing with the shifts in legality and public perceptions in the United States,” Halis K. Akturk, MD, assistant professor of medicine and pediatrics at the Barbara Davis Center for Diabetes at the University of Colorado Anschutz Medical Campus, and colleagues wrote. “Studies have reported improvement in insulin sensitivity and pancreatic beta cell function with cannabis use, generating widespread media attention suggesting cannabis as a potential therapeutic agent for treatment of type 2 diabetes.”
However, limited data suggest that cannabis use may contribute to diabetic ketoacidosis in type 1 diabetes, according to the researchers. To determine the association of cannabis use with diabetic ketoacidosis, Akturk and colleagues administered an in-person questionnaire to 450 adults aged 18 years or older with type 1 diabetes (mean age, 36.8 years; 44.6% women; mean diabetes duration, 19.5 years; mean HbA1c level as percent of total hemoglobin, 7.8%).
The questionnaire asked about demographic characteristics, diabetes history and complications, severe hypoglycemia requiring assistance and cannabis use. The researchers also measured point-of-care HbA1c level during the visit. They defined hazardous cannabis use as a Cannabis Use Disorder Identification Test-Revised score of 8 or more but less than 12 and possible cannabis use disorder as a score of 12 or more.
About 30% of participants reported using cannabis. Most reported using cannabis four or more times per week (40.3%), followed by one time or less per month (35.8%), two to three times per week (12.7%) and two to four times per month (10.4%). Three-quarters of participants reported using cannabis for recreation, while a quarter reported use for nondiabetes-related medical reasons and 17.9% reported use for diabetes-related reasons.
Cannabis users were more likely to be younger (mean age, 31.3 years vs. 39.1 years), have lower income and educational levels as well as a shorter duration of diabetes (mean duration, 16.3 years vs. 20.9 years), compared with nonusers.
There was an association between cannabis use within the previous 12 months and increased risk of diabetic ketoacidosis among patients with type 1 diabetes (OR = 1.98; 95% CI, 1.01-3.91). The mean HbA1c level was higher among cannabis users than nonusers (8.4% vs. 7.6%). Incidence of severe hypoglycemia did not differ between the two groups (15.6% vs. 20.3%). After adjustment for insulin delivery method, income and age, the mean HbA1c level was 0.41% higher among cannabis users, compared with nonusers.
“Cannabinoids alter gut motility and cause hyperemesis, which may play a role in increased risk for diabetic ketoacidosis in type 1 diabetes,” Akturk and colleagues concluded. “A small sample size, single-center, and self-reported diabetes outcomes are limitations of the present study. The possibility of unmeasured confounders, such as access to health care, cannot be excluded. Further research is needed to confirm these findings and understand the effects and adverse consequences of cannabis use in patients with type 1 diabetes.” – by Alaina Tedesco
Disclosures: Akturk reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.