Abstract
Our objective was to address the request by our Diabetes Canada/Canadian Institutes
of Health Research–funded Virtual Patient Network (VPN) of youth and young adults
with type 1 diabetes for information on the impact of cannabis use on type 1 diabetes.
To respond to this patient-initiated request, we conducted a literature search in
PubMed, with search terms relevant to the following: cannabis use in youth with type
1 diabetes, effects of cannabis use on glycemic control and diabetic emergencies and
immune-modulating properties of cannabis. These were synthesized in a narrative review.
The number of studies is limited and is based largely on self-report and cross-sectional
assessment. The existing literature indicates that 10% to 30% of youth and young adults
with type 1 diabetes report ever using cannabis, similarly to the general population.
Use appears to be associated with higher glycated hemoglobin and greater diabetic
ketoacidosis incidence. There is some evidence of poorer self-management during episodes
of use. Cannabis has been shown to be protective against type 1 diabetes in animal
models, but such findings have yet to be replicated in humans. Existing cross-sectional
studies suggest adverse effects of cannabis use on glycemic control and self-management.
However, it is not clear if the associations identified are due to use itself or other
patient or contextual factors. Nonetheless, given high use rates, health-care providers
should query use, discuss its potential impact on diabetes management and outcomes,
and codevelop an action plan.
Résumé
Notre objectif était de traiter la demande du réseau VPN (Virtual Patient Network)
financé par les IRSC et Diabète Canada pour les jeunes et les jeunes adultes atteints
du diabète de type 1 concernant des renseignements sur les conséquences de l'utilisation
du cannabis sur le diabète de type 1. Pour répondre à la demande des patients, nous
avons mené une recherche bibliographique dans PubMed à l'aide de termes de recherche
en rapport avec ce qui suit: l'utilisation du cannabis chez les jeunes atteints du
diabète de type 1, les effets de l'utilisation du cannabis sur la régulation de la
glycémie et les urgences liées au diabète, et les propriétés immunomodulatrices du
cannabis. Tous ces thèmes ont fait l'objet d'une synthèse dans une revue narrative.
Le nombre d'études est limité et repose en grande partie sur l'auto-déclaration et
l'évaluation transversale. La littérature existante indique que de 10 % à 30 % des
jeunes et des jeunes adultes atteints du diabète de type 1 déclarent, tout comme la
population générale, avoir déjà utilisé du cannabis. L'utilisation semble associée
à une hémoglobine glyquée plus élevée et à un nombre plus grand de cas d'acidocétose
diabétique. Des données montrent que la prise en charge autonome est plus mauvaise
durant les périodes d'utilisation. Les modèles animaux ont permis de démontrer que
le cannabis protège contre le diabète de type 1, mais ces résultats n'ont pas encore
été reproduits chez les humains. Les études transversales existantes montrent que
l'utilisation du cannabis a des effets indésirables sur la régulation de la glycémie
et la prise en charge autonome. Toutefois, il est difficile de savoir si les associations
établies sont dues à l'utilisation en soi ou à d'autres facteurs en lien avec le patient
ou le contexte. Néanmoins, compte tenu des taux élevés d'utilisation, les prestataires
de soins de santé devraient se questionner sur l'utilisation, discuter de ses conséquences
potentielles sur la prise en charge et les résultats liés au diabète, et élaborer
conjointement un plan d'action.
Keywords
Mots clés
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References
- Summary of results for 2017.https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey/2017-summary.htmlDate accessed: January 23, 2019
- Epidemiology of type 1 diabetes. Endocrinology and metabolism clinics of North America.Endocrinol Metab Clin North Am. 2010; 39: 481-497
- Managing young people with type 1 diabetes in a ‘rave’ new world: Metabolic complications of substance abuse in type 1 diabetes.Diabet Med. 2009; 26: 328-333
- Information for health care professionals: Cannabis (marihuana, marijuana) and the cannabinoids.Health Canada, Ottawa2018
- The health and social effects of nonmedical cannabis use.WHO, Geneva2016
- Recreational drug use in type 1 diabetes: An invisible accomplice to poor glycaemic control?.Intern Med J. 2012; 42: 198-202
- Adolescents with type 1 diabetes and risky behaviour.Acta Paediatr. 2010; 99: 1237-1241
- Tobacco, alcohol, and illicit drug use in adolescents with diabetes mellitus.Pediatr Diabetes. 2007; 8: 265-271
- Risky behavior and risk in adolescents in IDDM.J Adolesc Health. 1997; 20: 38-45
- Substance use among adolescents with diabetes mellitus: Preliminary findings.J Adolesc Health. 1993; 14: 80-84
- Alcohol and drug use in teenagers with diabetes mellitus.J Adolesc Health. 1991; 12: 11-14
- “Mind the gap” when managing ketoacidosis in type 1 diabetes.Diabetes Care. 2008; 31: e58
- Association between cannabis use and risk for diabetic ketoacidosis in adults with type 1 diabetes.JAMA Intern Med. 2019; 179: 115-118
- Substance use in adults with type 1 diabetes in the T1D Exchange.Diabetes Educ. 2018; 44: 510-518
- Prevalence of alcohol, tobacco, cannabis and other illicit substance use in a population of Canadian adolescents with type 1 diabetes compared to a general adolescent population.Paediatr Child Health. 2018; 23: 185-190
- Breaking the taboo: Illicit drug use among adolescents with type 1 diabetes mellitus.J Diabetes Res. 2016; 2016: 4153278
- Alcohol and marijuana use and treatment nonadherence among medically vulnerable youth.Pediatrics. 2015; 136: 450-457
- Street drug use among young patients with type 1 diabetes in the UK.Diabet Med. 2004; 21: 295-296
- Psychological adjustment to IDDM: 10-year follow-up of an onset cohort of child and adolescent patients.Diabetes Care. 1997; 20: 811-818
- Knowledge and practice of harm-reduction behaviours for alcohol and other illicit substance use in adolescents with type 1 diabetes.Paediatr Child Health. 2019; 24: e51-e56
- Cannabis masks diabetic ketoacidosis.BMJ Case Rep. 2011; 2011 (bcr0220102716)
- An unusual cause of recurrent diabetic ketoacidosis in type 1 diabetes.Am J Med. 2016; 129: e139-e140
- Medical cannabis: Another piece in the mosaic of autoimmunity?.Clin Pharmacol Ther. 2017; 101: 230-238
- Cannabidiol lowers incidence of diabetes in non-obese diabetic mice.Autoimmunity. 2006; 39: 143-151
- The cannabis crop.Nature. 2015; 525: S2-S3
- About cannabis.https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about.htmlDate accessed: March 21, 2019
- Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: A case-control study.Lancet Psychiatry. 2015; 2: 233-238
- Cannabis legalization and regulation.https://www.justice.gc.ca/eng/cj-jp/cannabisDate accessed: March 20, 2019
- The effect of evening alcohol consumption on next-morning glucose control in type 1 diabetes.Diabetes Care. 2011; 24: 1888-1893
- Effects of smoked marijuana on food intake and body weight of humans living in a residential laboratory.Appetite. 1988; 11: 1-14
- Endocannabinoid control of food intake and energy balance.Nat Neurosci. 2005; 8: 585-589
- New insights on the role of the endocannabinoid system in the regulation of energy balance.Int J Obes. 2016; 40: 210-219
- Obesity and cannabis use: Results from 2 representative national surveys.Am J Epidemiol. 2011; 174: 929-933
- The impact of marijuana use on glucose, insulin, and insulin resistance among US adults.Am J Med. 2013; 126: 583-589
- Efficacy and safety of cannabidiol and tetrahydrocannabivarin on glycemic and lipid parameters in patients with type 2 diabetes: A randomized, double-blind, placebo-controlled, parallel group pilot study.Diabetes Care. 2016; 39: 1777-1786
- Cannabis smoking and diabetes mellitus: Results from meta-analysis with eight independent replication samples.Epidemiology. 2015; 26: 597-600
- Adverse health effects of marijuana use.N Engl J Med. 2014; 370: 2219-2227
- What has research over the past two decades revealed about the adverse health effects of recreational cannabis use?.Addiction. 2015; 110: 19-35
- Cannabis and Canada's children and youth.Paediatr Child Health. 2017; 22: 98-102
- Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review.Lancet. 2007; 370: 319-328
- Cannabis use in adolescence and risk for adult psychosis: Longitudinal prospective study.BMJ. 2002; 325: 1212-1213
- Adolescent substance use and educational attainment: An integrative data analysis comparing cannabis and alcohol from three Australasian cohorts.Drug Alcohol Depend. 2015; 156: 90-96
- Cannabis effects on driving skills.Clin Chem. 2013; 59: 478-492
- Impact of age at onset of cannabis use on cannabis dependence and driving under the influence in the United States.Accid Anal Prev. 2015; 76: 1-5
- Alcohol use in young adults with type 1 diabetes mellitus.Am J Lifestyle Med. 2017; 11: 433-435
- Lower-risk cannabis use guidelines: A comprehensive update of evidence and recommendations.Am J Public Health. 2017; 107: e1-12
- Nutrition, metabolism and diabetes connections.http://www.cihr-irsc.gc.ca/e/51006.htmlDate accessed: March 26, 2019
- The most common cannabis slang from around the globe.https://www.marijuana.com/news/2017/10/the-most-common-cannabis-slang-from-around-the-globeDate accessed: March 21, 2019
- Products and how to consume.https://weedmaps.com/learn/products-and-how-to-consume/cannabis-concentratesDate accessed: March 20, 2019
- All cannabis.https://www.bccannabisstores.com/collections/cannabis-productsDate accessed: March 20, 2019
- All cannabis products.https://ocs.ca/collections/all-cannabis-productsDate accessed: March 20, 2019
- Products.
- Adverse health effects of non-medial cannabis use.Lancet. 2009; 374: 1383-1391
Article Info
Publication History
Published online: May 14, 2019
Accepted:
May 6,
2019
Received in revised form:
April 4,
2019
Received:
February 27,
2019
Identification
Copyright
© 2019 Canadian Diabetes Association.
