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Recent studies have revealed a concerning trend: cannabis use is on the rise among individuals with diabetes, presenting new challenges for healthcare professionals. A U.S. prevalence study found that 9% of adults with diabetes used cannabis in the last month, marking a 33.7% increase between 2021 and 2022. Notably, almost half (48.9%) of these users were under 50 years old. Even more striking is the growing use of cannabis among individuals aged 65 years or older, many of whom are managing chronic conditions such as diabetes.
While perceptions of cannabis risk have declined, particularly among older adults, the data paints a more complex picture. This demographic is at higher risk for emergency department visits related to cannabis poisoning. As cannabis legalization expands, endocrinologists are likely to encounter more patients of all ages using or inquiring about cannabis, yet evidence-based guidelines remain scarce.
The Lack of Evidence and Need for Research
Dr. Jay Shubrook, DO, a professor and diabetologist at Touro University California, highlighted the challenge in advising patients. “The evidence on cannabis is limited mainly because of its scheduling in the United States,” he explained. Cannabis has long been classified as a Schedule I drug, which has restricted its availability for human trials. However, a recent U.S. Department of Justice proposal to reclassify marijuana as a Schedule III drug could open the door for more comprehensive studies.
Even in Canada, where recreational cannabis has been legal since 2018, data on its effects on diabetes management are limited. In 2019, Diabetes Canada issued a position statement on cannabis use in people with type 1 and type 2 diabetes, though their recommendations were based on low-grade evidence, and much of the research did not account for the various methods of cannabis consumption, which can carry differing health risks.
Understanding Cannabis Use in Diabetes Patients
Cannabis contains more than 100 active compounds, with tetrahydrocannabinol (THC) being the most well-known for its psychoactive effects. Cannabidiol (CBD), another active compound, is not mind-altering but has gained popularity for its purported therapeutic benefits. Patients may use cannabis in various forms, including smoking, vaping, or ingesting it through edibles. However, the lack of standardized dosage recommendations for cannabis strains, THC/CBD ratios, and methods of administration adds complexity to its use in patients with diabetes.
In the U.S., higher THC levels are a growing concern. The potency of cannabis has increased significantly over the years, from about 4% THC in 1995 to approximately 14% in 2019, raising questions about the long-term effects of high-THC consumption, particularly in vulnerable populations like those with diabetes.
Potential Health Risks and Benefits
For people with diabetes, the risks of cannabis use vary depending on how it is consumed. A key concern is the potential negative impact on metabolic factors and self-management behaviors, particularly in individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D). Studies have linked cannabis use to poorer glycemic control, an increased risk of diabetes-related complications, and diminished self-care, such as inadequate glucose monitoring and poor medication adherence.
However, some research has suggested that cannabis use may offer benefits, particularly in the context of chronic pain management and anxiety reduction. For example, a 15-week study found that a THC/CBD spray improved pain and sleep quality in patients with treatment-resistant neuropathic pain, while another small study reported that inhaled cannabis reduced pain from diabetic peripheral neuropathy.
A study led by Dr. Angela Bryan at the University of Colorado Boulder also reported that chronic cannabis users had a lower body mass index and lower inflammation markers, which might reduce the risk of developing T2D. Yet these findings remain preliminary and require further investigation.
Advising Patients
Given the limited evidence, endocrinologists must approach cannabis use discussions with patients thoughtfully. Dr. Shubrook advises asking patients why they use cannabis, how they use it, and what effects they experience, including on glucose control. He emphasizes harm reduction, suggesting that patients avoid inhaling cannabis due to lung-related risks and opt for legal dispensaries to reduce the chance of contamination.
For patients with diabetes, especially those with T1D, healthcare professionals should provide personalized counseling on the risks associated with cannabis use. Diabetes Canada recommends avoiding cannabis use in individuals with T1D due to the heightened risk of diabetic ketoacidosis. For those who choose to use cannabis, regular conversations about its potential impact on diabetes management are essential.
The Road Ahead
As cannabis becomes more accessible, the healthcare community needs better resources to guide patients with diabetes. Both U.S. and Canadian diabetes associations acknowledge the current knowledge gap and are calling for more robust research to inform clinical practice. Until then, the key for endocrinologists will be ongoing patient education and open communication about the risks and potential benefits of cannabis use in diabetes care.
Key Takeaways:
- Cannabis use is rising among adults with diabetes, especially in older populations.
- The evidence on cannabis and diabetes management is limited, with concerns about its impact on metabolic factors and self-care.
- Healthcare professionals should engage in nonjudgmental conversations about cannabis use and emphasize harm reduction strategies.
