Visual Abstract

Cannabis use is known to increase DKA risk in adults with T1D. We evaluated diabetes self-management, glycemic control, and its relationship with DKA risk in T1D by cannabis use. Adults with T1D followed at the Barbara Davis Center were invited for a survey between September and October of 2020. Information on demographics, cannabis use (CUDIT-R), self-reported DKA in the past year, self-reported A1c, and diabetes self-management (DSMQ) were collected using validated questionnaires. Of 905 respondents, 238 reported using cannabis (26.2%). Cannabis users were younger (mean±SD 31±12 vs. 37 ±15 y, p<0.0001), often men (42% vs. 33%, p=0.025), had shorter T1D duration (17±11 vs. 21±14 y, p<0.0001), higher A1c (7.8±1.7% vs. 7.4±1.5%, p=0.0006), lower use of pump (55% vs. 71%, p<0.0001) and continuous glucose monitoring (75% vs. 84%, p= 0.002), frequently missing meal-time (65% vs. 53%, p= 0.0015) or long-acting insulin (22% vs. 12%, p= 0.0011), and lower DSMQ scores (19±5 vs. 21±4, p<0.001) compared to non-users. Cannabis use was associated with a 1.8-fold increased DKA risk (10.08% vs. 6.02%, p=.0363), and the association attenuated when adjusted for HbA1c, pump use, DSMQ score and missing insulin doses (Figure). In adults with T1D, cannabis users had 2 fold increase in DKA risk, probably attributable to missing insulin doses and poor diabetes self-management leading to high A1c compared non-users.

Disclosure

D. Giese: None. G. L. Kinney: None. C. Geno rasmussen: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. V. Shah: Advisory Panel; Self; Medscape, Sanofi, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi, vTv Therapeutics.

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