Purpose: Substance use and sexual activity can impact the glycemic management and health of people living with type 1 diabetes (T1D), but data in pediatric populations are sparse. We set out to explore patient engagement and knowledge of the impacts on glycemia from substance use and sexual activity in a pediatric type 1 diabetes center. Patients and methods: Surveys assessing rates and frequency of cannabis use, alcohol use, sexual activity, and participants’ knowledge of their glycemic impacts were administered to participants ≥ 18 years old with type 1 diabetes between July 2024 and May 2025 at the Barbara Davis Center for Diabetes pediatric clinic. Respondents were classified by substance use (alcohol and/or cannabis) and sexual activity. Demographic and glycemic data were obtained from electronic medical records. Student’s t -tests and chi-square tests were performed to compare between groups. Linear regression models were fit to compare HbA1c by cannabis use, adjusting for age, diabetes duration, non-Hispanic White race and ethnicity, and automated insulin delivery use. Results: Of the 103 participants, 50 (48.5%) and 56 (54.4%) reported cannabis and alcohol use, respectively. Sexual activity was reported by 63 (61.2%) individuals. Cannabis users had a 0.8% higher HbA1c compared to non-users, even when controlling for confounders, and were less knowledgeable about its impact on glucose levels. Alcohol users were more knowledgeable about alcohol’s impacts compared to non-users, especially concerning delayed hypoglycemia. Knowledge of goal HbA1c during pregnancy was low. Conclusion: Substance use and sexual activity are common among emerging adults with T1D, though their knowledge around the impact on diabetes is limited. Consistent and comprehensive education on these topics should begin early as part of routine diabetes care in pediatric populations. Further research into the effect of cannabis on glucose levels and diabetes care is necessary. Keywords: cannabis, alcohol, sexual activity, emerging adults, type 1 diabetes
WATERMAN et al. (Sun,) studied this question.