Cannabis use may come with an unexpected cost: a nearly fourfold rise in diabetes risk.

The finding, drawn from millions of health records, challenges assumptions about the drug’s effects and underscores the need for closer medical monitoring.

Cannabis Use and Diabetes Risk

Cannabis use has been associated with nearly a fourfold increase in the likelihood of developing diabetes, according to an analysis of health data from more than 4 million adults. The findings are being presented at this year’s Annual Meeting of The European Association for the Study of Diabetes (EASD) in Vienna, Austria.

Worldwide, cannabis use continues to rise, with an estimated 219 million people (4.3% of the global adult population) reported as users in 2021. Despite widespread consumption, the long-term effects of this on metabolism remain poorly understood. Some earlier research has suggested potential benefits, including anti-inflammatory properties and support for weight management. Others, however, have pointed to concerns about how cannabis might affect glucose regulation and insulin resistance, and the scale of the potential diabetes risk has remained uncertain.

Large-Scale Real-World Data Analysis

To provide stronger evidence, Dr. Ibrahim Kamel of Boston Medical Center in Massachusetts, USA, and his team reviewed electronic health records collected from 54 healthcare institutions within the TriNetX Research Network, which includes sites across the USA and Europe. Their analysis identified 96,795 outpatients (aged 18 to 50 years, 52.5% female) with cannabis-related diagnoses between 2010 and 2018. These diagnoses ranged from occasional use to dependence and also included cases involving intoxication or withdrawal.

For comparison, the researchers matched this group with 4,160,998 individuals with no history of substance use or major chronic disease, aligning them by age, sex, and baseline health conditions. All participants were then tracked over a five-year period.

Nearly Fourfold Risk After Adjustments

After controlling HDL and LDL cholesterol, uncontrolled high blood pressure, atherosclerotic cardiovascular disease, cocaine use, alcohol use and several other lifestyle risk factors, the researchers found that new cases of diabetes were significantly higher in the cannabis group (1,937; 2.2%) compared to the healthy group (518; 0.6%), with statistical analysis showing cannabis users at nearly four times the risk of developing diabetes compared to non-users.

While the authors note that more research is needed to fully explain the association between cannabis and diabetes, it may come down to insulin resistance and unhealthy dietary behaviors. Nevertheless, the study’s results have immediate implications for metabolic monitoring practices and public health messaging.

Public Health Implications and Warnings

“As cannabis becomes more widely available and socially accepted, and legalized in various jurisdictions, it is essential to understand its potential health risks,” said lead author Dr. Kamel. “These new sights from reliable real-world evidence highlight the importance of integrating diabetes risk awareness into substance use disorder treatment and counseling, as well as the need for healthcare professionals to routinely talk to patients about cannabis use so that they can understand their overall diabetes risk and potential need for metabolic monitoring.”

Unanswered Questions and Study Limitations

The authors note that more research is needed on the long-term endocrine effects of cannabis use and whether diabetes risks are limited to inhaled products or other forms of cannabis, such as edibles.

Despite the important findings, this is a retrospective study and cannot prove that cannabis use causes diabetes, and the authors cannot rule out the possibility that other unmeasured factors may have influenced the results despite efforts to reduce confounding bias via propensity score matching. This study has limitations due to a lack of detailed cannabis consumption data and potential misclassification. The authors acknowledge that inherent limitations of real-world data often result from inconsistent patient reporting in electronic medical records. They also note that there is a risk of bias because of imprecise measures of cannabis exposure and the reliance on participants to accurately report any cannabis use, even when they lived in places where the drug is illegal.

Meeting: Annual Meeting of the European Association for the Study of Diabetes (EASD)

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