Cannabis use is associated with an increased risk for diabetic ketoacidosis among adults with type 1 diabetes, US researchs shows.

Given the widespread popularity of cannabis for recreational and medical purposes, the findings suggest that its use should be routinely discussed with people with T1D according to  Dr Greg Kinney and colleagues form the University of Colorado, Denver.

Writing in Diabetes Care, the say their study of 932 adults with type 1 diabetes, found that 61 had a moderate use of cannabis, as defined by a total substance score greater than 4.

After adjusting for sex, age and HbA1c, moderate cannabis use was associated with a two-fold increase in risk for DKA in the previous 12 months among adults with type 1 diabetes (odds ratio 2.5 [95% CI 1.0–5.9]).

Moderate cannabis users tended to be younger, male and less likely to use CGM, but showed no differences from other diabetes patients in terms of insulin use, frequency of hypoglycaemia.

The researchers said it was not clear if the association between cannabis use and DKA was causal, but noted that there were several plausible mechanisms of action that may explain such as link.

Cannabinoid inhibition of gut motility and the rate of gastric emptying may lead to poor glycaemic control, they said.

“Moreover, cannabis-induced increase in appetite may result in increased glycaemic excursions, and users may experience higher overnight glucose and an altered perception of hypoglycemia because of cannabis impairing their ability to manage diabetes.,” they wrote.

Cannabis hyperemesis syndrome, which is characterised by cyclic episodes of nausea and vomiting may also result in an increased risk for DKA, they added

“This potentially problematic aspect of cannabis use should be assessed in patients with type 1 diabetes,” the authors recommended.

“Providers should discuss with their patients who use cannabis the possibility of altered glycaemic control, cannabis hyperemesis syndrome, and DKA,” they said.