Date of Award

Spring 2022

Document Type

Open Access Dissertation


Epidemiology and Biostatistics

First Advisor

Anwar T. Merchant


This dissertation sought to contribute to the evidence-base of diabetes management and acute complications associated with alcohol and cannabis use among individuals with Type 1 Diabetes (T1DM). Three interconnected studies were initiated to complete this goal. First, existing literature surrounding the potential consequences of cannabis consumption among individuals with T1DM were summarized within a systematic review. Study results were combined to provide a single measure of association through a meta-analysis. Second, identified associations were further investigated through a cross-sectional study using the SEARCH for Diabetes in Youth data on alcohol and cannabis use on diabetes management and acute complications including hemoglobin A1c (HbA1c), diabetic ketoacidosis (DKA) and severe hypoglycemic (SH) events. Third, the first longitudinal investigation on alcohol and cannabis use and associations with DKA and SH events was carried out.

Increased rates of DKA, higher HbA1c, and lower adherence to medication regimen among cannabis users with T1DM were identified through the Systematic Review. Increased frequencies of DKA and higher HbA1c were also found to be associated with cannabis use in the cross-sectional investigation. Additionally, an inverse relationship between binge drinking and SH events was found. Results of the longitudinal study again indicated consistent evidence for cannabis users with T1DM experiencing increased rates of DKA when compared to non-cannabis users over time. Similarly, binge drinkers with T1DM were again found to exhibit a significant inverse relationship with SH events when compared to non-drinkers over time.

Collectively, these three manuscripts summarized the existing, yet sparse, evidence of substance use on diabetes management and acute complications while also further validating and adding to the existing literature through both cross-sectional and longitudinal analyses on individuals with T1DM.

Available for download on Friday, May 31, 2024

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