8 RESEARCH UPDATE
Cannabinoids for pain and Covid risks of diabetes drugs
A summary of new research into the use of cannabinoids in chronic pain , and the relative risk of glucose-lowering drugs for Covid-19 mortality
Cannabinoids to treat chronic pain Cannabinoid therapy , such as CBD oil , is becoming more widely used and promoted to treat pain . More patients are now seeking advice about its use and side-effects from primary care professionals .
Jain and colleagues ( 2021 ) used an observational cross-sectional study to compare the views of rheumatology patients and GPs . They designed a questionnaire to explore participants ’ perceptions , experience and knowledge relating to the use of cannabinoids to manage chronic pain .
The study involved 100 GPs , and 102 patients attending a rheumatology clinic in the Leicestershire area . Of the GP group , which included GP trainees , 34 % said they ’ d had patients enquire about cannabinoids , but only 11 % had prescribed them and 78 % did not believe in their effectiveness . Of the patients , 16 % said they used cannabinoids for chronic pain , all of whom reported signifi cant improvement . The majority of non-users ( 60 %) said they were interested in more information .
There was a signifi cant difference in awareness and perceptions of effectiveness between the two groups . Patients were much more aware of the use of such complementary medicines than GPs , and almost half of patients wanted cannabinoids to be available on the NHS , against just over a quarter of GPs . This study raises important points and highlights the need for further disease- and drug-focused research in cannabinoid therapy .
Since cannabinoid therapy in various forms is available over the counter , patients are likely to ask for it on NHS prescription . However , cannabis remains a controlled drug licensed to be prescribed by specialists for indications that do not include chronic pain ( NICE , 2019 ). No guidelines exist for its use in primary care .
The study includes a literature review and provides useful information to inform clinicians ’ discussions with their patients .
References Jain N et al . Perception and belief on cannabinoids . Cureus 2021 ; 13 ( 3 ): e13756 . bit . ly / 3fNhCMD NICE . Cannabis-based medicinal products . nice . org . uk / ng144
Reena Patel is a practice nurse in Leicester
Diabetes medication and Covid mortality The pandemic has led clinicians to review patients with type 2 diabetes due to their increased risk of mortality . Hyperglycaemia has been shown to be an independent risk factor in these patients .
Khunti and colleagues ( 2021 ) conducted a nationwide observational cohort study , looking at 2.85 million type 2 diabetes patients registered with a general practice in England , using data from the National Diabetes Audit .
The study investigated associations between different classes of glucose-lowering drugs and risk of Covid-related mortality . It found some evidence that choice of glucose-lowering therapy could be a contributing factor in mortality . However , the differences in risk were small and subject to confounding factors , such as age , frailty and cardiorenal comorbidity .
Patients with diabetes account for up to a third of pandemic-related deaths in some countries , so the relation between glucoselowering drugs and Covid-19 is important for patients , clinicians and policymakers .
While the difference in risk was found to be small , the study did fi nd statistical evidence that people prescribed metformin , SGLT2 inhibitors , and sulfonylureas had a lower mortality risk compared with those not prescribed these drugs . Conversely , the risk was higher in those prescribed insulin and DPP-4 inhibitors than those not prescribed these drugs .
However , it acknowledges that insulin and DPP-4 inhibitors are often add-on therapies at a later stage of diabetes . Oral therapy is preferred by patients and is often the fi rst-line treatment ; by the time the patient is put on insulin irreversible complications may have already occurred . DPP-4 is a choice commonly used in elderly and frail patents due to its minimum side-effects , so patients prescribed that may already be more vulnerable .
The research provides clinicians in primary and secondary care with reassurance that there is , as yet , no clear indication to jeopardise glucose control or other potential benefi ts of specifi c drugs by changing diabetes medications in people with type 2 diabetes in daily practice . The authors called for further research to validate their fi ndings .
Reference Khunti K et al . Prescription of glucose-lowering therapies and risk of Covid-19 mortality in people with type 2 diabetes . Lancet 2021 ; 9 5 ): 293-303 . bit . ly / 2SBxxFW nursinginpractice . com Summer 2021