Recreational Marijuana in Diabetes: Not All Fun and Games

Harpreet S. Bajaj, MD, MPH

Hi. I'm Harpreet Bajaj, an endocrinologist in Toronto, Canada. Today I'm going to talk about recreational cannabis use and how it may impact diabetes.

Recreational cannabis use is a growing issue. In Canada, cannabis (or marijuana) was legalized about a year ago. Recreational cannabis is legally available in some US states and other countries, and is also used illegally in many parts of the world.

There is a dearth of evidence and literature on cannabis use in diabetes, and healthcare providers have a knowledge gap about how cannabis use may affect people with type 1 or type 2 diabetes. How we should counsel them?

Diabetes Canada released the first position statement on recreational cannabis use in people with type 1 and type 2 diabetes. Before I discuss the statement, I'd like to highlight that there are data limitations. High-grade evidence does not exist regarding cannabis use and how it may impact glycemic control or self-care behaviors among people with diabetes. Most data exist as observational cohort studies and are of lower grade than we would like.

With that caveat, the Diabetes Canada position statement is important and should be taken into consideration when discussing cannabis use with our patients. The first point is that glycemic control in people with diabetes was found to be somewhat worse, in addition to self-care behaviors, which might tie in to the reduced glycemic control. Self-care behaviors include glucose testing, following instructions, and taking medications, and these are affected among those who use recreational cannabis on a regular basis.

There is also low-grade evidence that this might impact some of the complications that result from worse glycemic control. What may be most important among people with type 1 diabetes is that we have evidence to suggest an increased risk for diabetic ketoacidosis in people who use cannabis recreationally.

Educate Your Patients

What are the take-home messages for healthcare providers? First, discuss cannabis use with your patients with type 1 or type 2 diabetes. Similar to conversations about alcohol use, ask them in a nonjudgmental fashion if they use cannabis or marijuana.

Then, discuss—within the limitations of the literature—that there might be potential harm to using cannabis in terms of glycemic control, self-care behaviors, and complications, including diabetic ketoacidosis in type 1 diabetes.

Finally, individualize the counseling you provide. You know your patient. We need to approach each patient sitting in front of us with the aim of individualizing education for that patient's benefit.

I hope this information was useful to you. Thank you.