Abstract
BackgroundRecent surveys of Canadian cannabis users reflect increasing consumption rates, some of whom may have diabetes. However, healthcare providers have limited information resources on the effects of recreational cannabis in people with diabetes. This rapid review was commissioned by Diabetes Canada to synthesize available evidence to guide recommendations for care of people 13 years of age and older who live with diabetes.MethodsPubMed, Embase and PsycINFO databases were searched from January 2008 to January 2019. Study selection, data abstraction and quality appraisal were completed by pairs of reviewers working independently and discrepancies were resolved by a third reviewer with pilot tests completed before each stage to ensure consistency. Data collected from included studies were tabulated and summarized descriptively.ResultsThe search resulted in 1848 citations of which 59 publications were selected for screening, resulting in six observational studies (2 full-text articles and 4 conference abstracts) that met the pre-defined criteria for inclusion. Five studies reported higher glycated hemoglobin (HbA1c) in people with type 1 diabetes (T1D) who consumed recreational cannabis. In one study, students aged 17 to 25 years living with T1D self-reported poorer glycemic control and higher HbA1c when smoking cannabis. In one study of adults with T1D, cannabis use within the previous 12 months was associated with almost double the risk of diabetic ketoacidosis compared with no cannabis use (odds ratio [OR] 1.98; confidence interval [CI] [95% CI] 1.01–3.91). Risks for peripheral arterial occlusion and myocardial infarction were found to be higher in people with type 2 diabetes (T2D) who consumed recreational cannabis, and worse renal parameters were also reported in two separate studies of T1D and T2D.ConclusionsRecreational cannabis use may negatively impact diabetes metabolic factors and self-management behaviours in people with T1D. In people with T2D, recreational cannabis may increase risks for peripheral arterial occlusion, myocardial infarction and renal disease. However, the evidence base of this rapid review was limited to six observational studies of poor to fair methodological quality, and thus, further robust, higher quality research is required to confirm the potential impact of cannabis on diabetes.Systematic review registrationPROSPERO CRD42019122829
Highlights
Recent surveys of Canadian cannabis users reflect increasing consumption rates, some of whom may have diabetes
The evidence base of this rapid review was limited to six observational studies of poor to fair methodological quality, and further robust, higher quality research is required to confirm the potential impact of cannabis on diabetes
Comparator: Non-exposure to cannabis Outcomes: Metabolic factors related to diabetes (e.g., Glycated hemoglobin (HbA1c), blood glucose, weight, blood pressure, dyslipidemia), including complications (e.g., [Diabetic ketoacidosis (DKA)]) or diabetes self-management behaviours Study design: Any experimental, quasi-experimental or observational design with the exception of case studies/case series and knowledge syntheses, such as systematic or literature reviews pairs of reviewers was resolved by an independent third reviewer (PR, ND)
Summary
Recent surveys of Canadian cannabis users reflect increasing consumption rates, some of whom may have diabetes. Healthcare providers have limited information resources on the effects of recreational cannabis in people with diabetes This rapid review was commissioned by Diabetes Canada to synthesize available evidence to guide recommendations for care of people 13 years of age and older who live with diabetes. Over the past 6 years, consumption of recreational cannabis has increased, overall, with those aged 15 to 24 years consistently showing the highest rates of use according to reports by the National Cannabis Survey [1,2,3,4]. Even before legislation, 19% of survey respondents indicated that they anticipated using cannabis in 2019, 4% higher than reported consumption rates in 2018, and up to 30% of current cannabis users anticipated increasing their cannabis use in the year [5]. CBD does not have a strong interaction with CB1 and CB2 receptors, but rather has multiple other targets throughout the body such as the transient receptor potential cation channel subfamily V member 1 (TRPV1) nociceptive channels enabling modulation of peripheral hyperalgesia [9]
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