When to Consider Cannabinoid Hyperemesis Syndrome in T1D

TOPLINE:

Cannabis users with type 1 diabetes (T1D) can be misdiagnosed with diabetic gastroparesis on the basis of symptoms or presentation with or without gastric emptying tests; however, cannabinoid hyperemesis syndrome should be considered in those who are young and male and who have a short diabetes duration, high A1c levels, and no diabetic neuropathy.

METHODOLOGY:

• Cannabis use has increased in people with T1D due to legalization in the United States and Canada. Diabetic gastroparesis and cannabinoid hyperemesis syndrome in patients with T1D present with similar gastrointestinal symptoms but require different treatments. There are currently no gastrointestinal tests to differentiate between the two conditions.
• Researchers retrieved electronic medical records of 813 patients with T1D followed at the Barbara Davis Center for Diabetes between January 2019 and January 2024 to investigate the differences between patients with the two conditions.
• Patients were grouped into two categories: Cannabis users with cannabinoid hyperemesis syndrome (n = 86) and cannabis nonusers with diabetic gastroparesis (n = 94). Cannabinoid hyperemesis syndrome was diagnosed on the basis of Rome IV criteria, and cannabis use was confirmed by a positive urine drug test or documented cannabis use in chart notes; diabetic gastroparesis was diagnosed on the basis of American Diabetes Association criteria.
• Data on demographics; A1c levels; and diabetes duration, management, technology use, and complications (such as diabetic neuropathy, retinopathy, and nephropathy) were collected from electronic records.

TAKEAWAY:

• The cannabinoid hyperemesis syndrome group was younger (29 vs 54 years) and had a shorter diabetes duration (16 vs 41 years), higher A1c levels (9.2 vs 7.4%), fewer women (42% vs 69%), and less neuropathy (11% vs 29%) than the diabetic gastroparesis group (P < .05 for all); a higher proportion of people in the cannabinoid hyperemesis syndrome vs diabetic gastroparesis group were unable to reach an A1c goal of < 7% (73% vs 50%).
• Age, diabetes duration, sex, and A1c at goal were identified as significant predictors, yielding an area under the curve of 0.9765; the model showed concordance in 90.7% of patients with cannabinoid hyperemesis syndrome and 92.55% of patients with diabetic gastroparesis.

IN PRACTICE:

“It is essential to differentiate [cannabinoid hyperemesis syndrome] from [diabetic gastroparesis] in people with type 1 diabetes because both can cause frequent [emergency department] visits,” the authors wrote. 

“Our model was successful in differentiating [cannabinoid hyperemesis syndrome] from [diabetic gastroparesis] with > 90% accuracy,” they added.

SOURCE:

This study was led by Halis Kaan Akturk, Barbara Davis Center for Diabetes, University of Colorado, Aurora, Colorado, and was published online in Clinical Diabetes.

LIMITATIONS:

The single-center retrospective design of this study was a major limitation. Additional limitations were the possible presence of asymptomatic cases of diabetic gastroparesis and undocumented cannabis use.

DISCLOSURES:

No funding information was provided for this study. The authors reported having no potential conflicts of interest.