Cannabis Use Doubles Risk for Ketoacidosis in Type 1 Diabetes

Cannabis use appears to be associated with an increased risk for diabetic ketoacidosis (DKA) among people with type 1 diabetes, new research finds.

The results, from the T1D Exchange clinic registry (T1DX), were published online October 18 in Diabetes Care by Gregory L. Kinney, MPH, PhD, from the University of Colorado Anschutz Medical Campus, Aurora, and colleagues.

Of 932 adults with type 1 diabetes, the risk for DKA among the 61 moderate cannabis users was more than twofold greater than in nonusers.

This result is similar to one in a study reported a year ago, which found that 30% of adults with type 1 diabetes surveyed admitted to using cannabis and that they, too, had a doubling of risk for DKA.

"Cannabis is a known addictive substance, and this potentially problematic aspect of cannabis use should be assessed in patients with type 1 diabetes. Providers should discuss with their patients who use cannabis the possibility of altered glycemic control, CHS [cannabis hyperemesis syndrome], and DKA," Kinney and colleagues write.

Cannabis is now legal for medical or recreational use in more than half of U.S. states, and although cannabis use among people with type 1 diabetes is not well described in the literature, evidence from adolescents suggests that it does not differ from that in the general population, the authors note.

Large Study Finds DKA Risk With Cannabis Use

To try to better categorize cannabis use in type 1 diabetes, the researchers recruited the 932 participants, who were among 1000 from T1Dx invited to complete the Alcohol, Smoking and Substance Involvement Screening Test questionnaire. This instrument generates a total substance score for cannabis (TSC) of 0 to 33, using a point system derived from six questions about use.

The scores are used to classify participants by recommended intervention, with 0 to 3 being low risk/no intervention, 4 to 26 as moderate risk/brief intervention, and greater than 26 as high risk/intensive intervention.

The authors compared the "no intervention" group with those having higher exposure scores.

No participants fell into the highest use category for cannabis, but 61 had moderate use (TSC > 4).

The latter group was younger (31 vs 38 years), was more often male (54% vs 38%), had less academic education, had a younger age at diabetes diagnosis (13 vs 16 years), had a higher A1c (8.4% vs 7.7%), were less likely to be using continuous glucose monitoring (21% vs 34%), and performed less self-monitoring of blood glucose.

Race, insulin pump use, frequency of severe hypoglycemia necessitating hospitalization, and alcohol use did not differ between the two

groups.

After adjustment for sex, age at study visit, and A1c, DKA was significantly associated with a TSC greater than 4, with an odds ratio of 2.5. Further adjustment for the legal status of cannabis in the state of the participant's residence didn't alter the association.

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