Cannabis Increases Risk of Ketoacidosis in Type 1 Diabetes Patients

A recent study associated cannabis use in patients with type 1 diabetes with a nearly twofold increased risk of diabetic ketoacidosis. 

The study, published in JAMA Internal Medicine, included 450 type 1 diabetes patients in Colorado (where marijuana is legal for recreational and medical purposes), of whom 30% reported using cannabis. The researchers found that compared with non-users, diabetic cannabis users had a 1.98 odds ratio (OR) for ketoacidosis (8.4% vs 7.6%; P < 0.01). 

The cannabis-use patients, when compared with non-users, tended to be younger (31 vs 39 years), less educated, have lower income, and more recently diagnosed (16 vs 20 years). 

Study patients overall had poorly controlled diabetes. The cannabis users had an average 8.4% hemoglobin A1c reading, while the non-cannabis patients had a mean 7.6%; typically, type 1 diabetes patients are advised to keep levels under 6.5%. 

In the present study, 134 respondents said they have used cannabis in the last 12 months; of these patients, 18% said it was for diabetes-related reasons. 

“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,” the researchers wrote. 

But previous studies have also linked cannabis use to ketoacidosis in type 1 diabetes patients, including research published in The American Journal of Medicine in 2016. 

Senior author of the present study Dr. Viral Shah, of the Barbara Davis Center for Diabetes at the University of Colorado Anschutz Medical Campus in Aurora, suggested in an email to Reuters that vomiting associated with long-term cannabis use may lead to dehydration and therefore elevated ketones and ketoacidosis. 

“Elevated ketones may be life threatening if not treated on time, and patients can [have] nausea, vomiting, abdominal pain, shortness of breath and rarely confusion or altered consciousness,” Dr. Shah wrote. “Diabetic ketoacidosis is an emergency and patient with diabetes should go to emergency room if they have symptoms.” 

The exact link is unclear and requires further research, Dr. Shah told 

“With increasing cannabis use in the USA, we need more research to understand how cannabis (or its different components) affects gut motility, glucose metabolism and risk for diabetes related complications,” he said, adding, of the current study, “This is a cross-sectional study and therefore, cause and effect relation between cannabis and diabetic ketoacidosis needs to be examined in future research.” 

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SourcesJAMA Internal Medicine, Medscape