A Phase I Randomized, Double-blind, Placebo-controlled Study on Efficacy and Safety Profile of a Sublingually Administered Cannabidiol /Delta 9-tetrahydrocannabidiol (10: 1) Regimen in Diabetes Type 2 Patients

The current study aimed to evaluate the safety profile and efficacy of a cannabis-based sublingual spray, CBDEX10® (containing 100 µg cannabidiol and 10 µg Δ9-tetrahydrocannabinol per puff; CBD/Δ9-THC 10:1), in improving lipid profile and glycemic state of the diabetic patients. Fifty diabetic patients were randomly allocated to the treatment (n = 25; receiving two puffs of CBDEX10® twice daily) or the control groups (n = 25; receiving two puffs of placebo). The primary endpoint of the study was to evaluate the efficacy of the CBDEX10® adjunctive therapy in improving the lipid profile and glycemic state of diabetic patients; the secondary endpoint was to assess the safety profile and tolerability of the spray. A statistically significant decline in total cholesterol [estimated treatment difference (ETD) = −19.73 mg/dL; P < 0.05], triglyceride (ETD = −27.84 mg/dL; P < 0.01), LDL-C (ETD = −5.37 mg/dL; P < 0.01), FBS (ETD = −12 mg/dL; P < 0.01), Hb A1C (ETD = −0.21 mg/dL; P < 0.01) and insulin secretion (ETD = -5.21 mIU/L; P < 0.01) was observable in the patients treated with CBDEX10® at the end of the 8-week treatment period. Regarding safety, the mentioned adjunctive regimen was well, and there were no serious or severe adverse effects. Overall, CBDEX1® sublingual spray could be a new therapeutic agent for lipid and glycemic control in diabetic patients.

[1]  M. Raei,et al.  Investigating the Prevalence of Substance Abuse Among Students of Medical Science Universities in the Eighth Macro-region of Iran , 2021, International Journal of High Risk Behaviors and Addiction.

[2]  A. Ubale,et al.  Adverse drug reaction monitoring in patients of hypertension at a tertiary care hospital, Aurangabad, Maharashtra, India , 2021 .

[3]  F. Guimarães,et al.  Cannabidiol improves metabolic dysfunction in middle-aged diabetic rats submitted to a chronic cerebral hypoperfusion. , 2019, Chemico-biological interactions.

[4]  T. England,et al.  A systematic review of cannabidiol dosing in clinical populations , 2019, British journal of clinical pharmacology.

[5]  B. Gidal,et al.  A Phase I, Randomized, Double-Blind, Placebo-Controlled, Single Ascending Dose, Multiple Dose, and Food Effect Trial of the Safety, Tolerability and Pharmacokinetics of Highly Purified Cannabidiol in Healthy Subjects , 2018, CNS Drugs.

[6]  A. Malfitano,et al.  Cannabidiol: State of the art and new challenges for therapeutic applications. , 2017, Pharmacology & therapeutics.

[7]  Juan Zhou,et al.  Experimental cannabidiol treatment reduces early pancreatic inflammation in type 1 diabetes. , 2017, Clinical hemorheology and microcirculation.

[8]  P. Flatt,et al.  Metabolic effects of orally administered small-molecule agonists of GPR55 and GPR119 in multiple low-dose streptozotocin-induced diabetic and incretin-receptor-knockout mice , 2016, Diabetologia.

[9]  Jimmy D Bell,et al.  Efficacy and Safety of Cannabidiol and Tetrahydrocannabivarin on Glycemic and Lipid Parameters in Patients With Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled, Parallel Group Pilot Study , 2016, Diabetes Care.

[10]  D. Khalili,et al.  The effect of a single dose of vitamin D on glycemic status and C-reactive protein levels in type 2 diabetic patients with ischemic heart disease: a randomized clinical trial , 2016, Acta Diabetologica.

[11]  V. Di Marzo,et al.  Are cannabidiol and Δ9‐tetrahydrocannabivarin negative modulators of the endocannabinoid system? A systematic review , 2015, British journal of pharmacology.

[12]  A. J. Wheal,et al.  Cannabinoids alter endothelial function in the Zucker rat model of type 2 diabetes. , 2013, European journal of pharmacology.

[13]  M. Mittleman,et al.  The impact of marijuana use on glucose, insulin, and insulin resistance among US adults. , 2013, The American journal of medicine.

[14]  Z. Sahraee,et al.  The Patients' Adherence and Adverse Drug Reactions (ADRs) which are Caused by Helicobacter pylori Eradication Regimens. , 2013, Journal of clinical and diagnostic research : JCDR.

[15]  M. Donath,et al.  Cannabis exposure associated with weight reduction and β-cell protection in an obese rat model. , 2012, Phytomedicine : international journal of phytotherapy and phytopharmacology.

[16]  M. Hellmich,et al.  Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia , 2012, Translational Psychiatry.

[17]  Keith C. Norris,et al.  Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III , 2012, BMJ Open.

[18]  L. Steardo,et al.  Cannabidiol Reduces Aβ-Induced Neuroinflammation and Promotes Hippocampal Neurogenesis through PPARγ Involvement , 2011, PloS one.

[19]  R. Kahn,et al.  Cannabis with high cannabidiol content is associated with fewer psychotic experiences , 2011, Schizophrenia Research.

[20]  S. Yamaori,et al.  Identification of cytochrome P450 enzymes responsible for metabolism of cannabidiol by human liver microsomes. , 2011, Life sciences.

[21]  A. Wierzbicki,et al.  Rimonabant improves cholesterol, insulin resistance and markers of non‐alcoholic fatty liver in morbidly obese patients: a retrospective cohort study , 2011, International journal of clinical practice.

[22]  A. Veves,et al.  Cannabidiol Attenuates Cardiac Dysfunction , Oxidative Stress , Fibrosis , and Inflammatory and Cell Death Signaling Pathways in Diabetic Cardiomyopathy , 2017 .

[23]  M. Gallant,et al.  Biological effects of THC and a lipophilic cannabis extract on normal and insulin resistant 3T3-L1 adipocytes. , 2009, Phytomedicine : international journal of phytotherapy and phytopharmacology.

[24]  R. Pertwee,et al.  The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: Δ9‐tetrahydrocannabinol, cannabidiol and Δ9‐tetrahydrocannabivarin , 2008 .

[25]  J. Després,et al.  Effects of rimonabant on metabolic risk factors in overweight patients with dyslipidemia. , 2005, The New England journal of medicine.

[26]  P. Soubrié,et al.  CB1 cannabinoid receptor knockout in mice leads to leanness, resistance to diet-induced obesity and enhanced leptin sensitivity , 2004, International Journal of Obesity.

[27]  C. Crespo,et al.  Dietary intake and nutritional status of US adult marijuana users: results from the Third National Health and Nutrition Examination Survey , 2001, Public Health Nutrition.

[28]  R. Foltin,et al.  Effects of smoked marijuana on food intake and body weight of humans living in a residential laboratory , 1988, Appetite.

[29]  S. Narouze,et al.  Phytocannabinoids: Tetrahydrocannabinol (THC) , 2021, Cannabinoids and Pain.

[30]  J. Ware,et al.  User’s manual for the SF36v2 Health Survey , 2011 .

[31]  R. Pertwee The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin. , 2008, British journal of pharmacology.