Abstract
Diabetic ketoacidosis (DKA) is an acute life-threatening complication of diabetes mellitus. It is responsible for greater than 100,000 hospital admissions per year in the US (1). There are few studies regarding the relationship between drug usage and acute diabetic complications (2). Since 2001, cannabis usage among US adults have more than doubled, as state legal restrictions have eased and attitudes towards cannabis have become more permissive. Cannabis is the most commonly used illicit drug in the US (3). Some studies suggested cannabis usage was associated with improvement in insulin sensitivity and pancreatic beta cell function. Other research demonstrated cannabis usage may contribute to diabetes-related hospitalizations.
A retrospective analysis was performed at an urban teaching hospital to examine the relationship between cannabis usage and risk for DKA upon presentation. From March 2017 to February 2019, all non-pregnant patients aged 18 years and older, and who met criteria for DKA admission upon medical records review, were included in the study. Demographics, vitals, biochemistry, and toxicology were evaluated. Overall, 188 admissions for DKA were identified in a total of 130 patients, and 43% (81/188) were readmissions by 23 patients.
Illicit substance usage was addressed by history in 72% (135/188) of all admissions, among which 24% (33/135) reported cannabis usage. 36% (67/188) of all admissions, 73% (24/33) of the self-reported cannabis usage group, and 46% (37/81) of the readmissions, underwent general toxicology screening that did not include detection for cannabis. 11% (20/188) of all admissions, 24% (8/33) of the self-reported cannabis usage group, and 16% (13/81) of the readmissions, completed toxicology screening specifically for cannabis.
All of the self-reported cannabis usage admissions (33/33) and readmissions (81/81) presented with additional aggravating factors for DKA such as medication noncompliance, polysubstance abuse, and infection. Finally, 20 of the overall 130 patients admitted during this timeframe presented with new onset DKA, where none reported cannabis usage, 20% (4/20) completed general toxicology screening, and none underwent cannabis specific toxicology screening.
From the observational retrospective analysis at this hospital, there is a need for awareness about substance abuse screening, especially in adults with a history of recurrent hospital admissions for DKA. Knowledge among health care providers and patient education regarding the effect of cannabis usage on metabolic factors and its diabetes complications, including diabetes self-management at time of drug usage, can be further explored in prospective studies.
References: (1) Umpierrez (2006) Diabetes Care, 29(12), 2755-2757. (2) Brown et al., (2017) JAMA, 317(2), 207. (3) Haffajee et al., (2018) NEJM, 379(6), 501-504.
Features and outcomes of unplanned hospital admissions of older people due to ill-defined (R-coded) conditions: Retrospective analysis of hospital admissions data in England