A new study revealed a significant increase in cannabis use among adults with diabetes in the United States. Investigators found that past-month cannabis use rose from 7.7% in 2021 to 10.3% in 2022, representing a 33.7% increase.
In the study, published in Diabetes Care, the investigators used the 2021 to 2022 National Survey on Drug Use and Health (NSDUH)—an annual cross-sectional nationally representative survey—to analyze the data of 6,816 patients aged 18 years or older who reported a lifetime diagnosis of diabetes. Past-month cannabis use was assessed by asking about the use of marijuana and cannabis products "excluding CBD or hemp products, and used by smoking, vaping, dabbing, eating or drinking, or applying as a lotion," the study authors noted.
Covariates included sociodemographic characteristics, perception of great risk of smoking cannabis monthly, past-year all-cause emergency department use, past-year major depression, past-month misuse of opioids and/or stimulants, tobacco use, and binge drinking. Statistical analysis included Rao Scott χ2 tests for comparisons and multivariable logistic regression to examine associations between covariates and cannabis use. Weights were used to account for the complex survey design, selection probability, nonresponse, and population distribution.
The investigators found that 9% of the adults with diabetes used cannabis in the past month between 2021 and 2022. Further, 48.9% of cannabis users with diabetes were under the age of 50 years compared with 20.4% of nonusers.
The investigators discovered that cannabis use among the adults with diabetes was slightly lower than national estimates for the general U.S. population (13.9% to 15.9%). However, they expressed concerns about the higher prevalence of other psychoactive substance use among those with diabetes who used cannabis.
Among the factors associated with a higher risk of past-month cannabis use among adults with diabetes were:
- Residence in states where cannabis is legal (adjusted odds ratio [OR] = 2.76, 95% confidence interval [CI] = 2.10–3.62)
- History of hepatitis (adjusted OR = 3.87, 95% CI = 1.58–9.49)
- Past-year major depressive episode (adjusted OR = 1.58, 95% CI = 1.03–2.43)
- Past-year emergency department use (adjusted OR = 1.46, 95% CI = 1.04–2.05)
- Past-month tobacco use (adjusted OR = 2.90, 95% CI = 2.13–3.96)
- Past-month binge drinking (adjusted OR = 2.21, 95% CI = 1.62–3.02)
- Past-month opioid misuse (adjusted OR = 6.37, 95% CI = 2.45–16.56)
- Past-month stimulant misuse (adjusted OR = 4.14, 95% CI = 1.39–12.32).
The investigators emphasized the importance of comprehensive substance use screenings in diabetes care, with a specific focus on cannabis. They noted that cannabis use may complicate diabetes management, potentially affecting glycemic control and self-management behaviors.
They acknowledged several limitations of the study:
- The lack of differentiation between types of diabetes or types of cannabinoid products used in the NSDUH
- Reliance on self-reported data, which may be subject to recall and social desirability bias
- Inclusion of only the noninstitutionalized U.S. population.
The investigators concluded that the increased use of cannabis among patients with chronic diseases, including diabetes, warrants careful monitoring. They highlighted the need for physicians to discuss the potential harms of cannabis use on diabetes-related outcomes with patients, given the limited understanding of its benefits.
One study investigator consulted for the Washington-Baltimore High Intensity Drug Trafficking Area Program. No other potential conflicts of interest relevant to this study were reported.