Type 2 Diabetes and Chronic Pain in China: The Therapeutic Potential of CBD

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by Kyle Yang -

China has the greatest number of type 2 diabetics in the world. Of 422 million adults in 2016 with this chronic disease, 129.3 million were in China. Almost 500 million more have pre-diabetes, in which blood sugar levels are disconcertingly elevated but not enough to prompt diagnosis of type 2 diabetes. The prevalence of type 2 diabetes among the Chinese has risen more than nine-fold in a single generation, faster than in the rest of world, which makes China home to almost one-third of the global diabetic population. Furthermore, it is estimated that more than one-half of those with diabetes in China are undiagnosed—which means the country could have almost 260 million diabetics.

Diabetes and its complications led to almost 1 million deaths in China in 2016. This public health problem is only getting worse, resulting in catastrophic healthcare expenditures. Yearly medical costs currently exceed $30 billion, and are accompanied by a bevy of social and economic difficulties. It is no surprise the Chinese government has sent out pleas for innovation to resolve the increasing burden of diabetes.

The prevalence of chronic pain among Chinese adults is likewise high.  At least 20 percent, or around 200 million, suffer from it, often concurrent with type 2 diabetes. Meanwhile, China has approximately 20 percent of the world's population, but 22 percent of new cancer cases and 27 percent of cancer deaths. Cancer pain is unequivocal, but breakthrough cancer pain with its severe intensity is especially excruciating. Nevertheless, the fear of addicting patients is a major barrier for physicians in prescribing opioid analgesics for both non-cancer and cancer pain. Patients are similarly reluctant due to concerns about addiction. This dilemma has historical roots. Opium was forcibly sold throughout the country by the British and Americans during the 1800s, and more than 25 percent of all Chinese men were addicts by the early 1900s. Opioids have since been considered a cultural taboo, and pain is woefully undertreated as a result. As such, healthcare authorities in China are urging the development of novel analgesic drugs with new mechanisms of action to replace opioids.

Cannabidiol (CBD), a safe, non-psychoactive substance found in hemp plants, may be an especially welcome therapeutic in China for treating not only type 2 diabetes and pain, but also chronic pain—especially the neuropathic type associated with diabetes and cancer chemotherapy.

CBD’s anti-inflammatory properties include the alluring penchant to reduce or eliminate tumor necrosis factor (TNF) in the body.  TNF exists at raised levels in the fatty tissue of both pre-diabetics and diabetics, and causes levels of abnormal inflammation enough to negatively impact insulin action. A vicious cycle can develop, with inflammation due to TNF leading to more insulin dysfunction and vice versa. In this regard, TNF becomes a causative factor in both pre-diabetes and type 2 diabetes. This makes TNF inhibition by CBD a tentatively valuable way to mitigate, reverse or even prevent pre-diabetes and type 2 diabetes. Pre-clinical studies on animals and observations on people taking CBD (done in advance of structured human clinical trials) indicate this may indeed be the case—which could mean China would indeed benefit from CBD therapy.

CBD also seems to have a significant capacity to suppress persistent inflammatory and neuropathic pain, although each differs in pathogenesis (the physiological mechanisms by which pain is expressed). In other words, chronic pain (regardless of the cause) could be alleviated by means of CBD therapy. Furthermore, human case studies indicate the analgesic propensity is profound enough for patients to voluntarily reduce or stop opioid use. This suggests an efficacy intense enough for opioid replacement around the world—and one sufficient for serious analgesic applications in China. That CBD is non-addictive, in addition to devoid of other significant side effects, makes it even more attractive as an analgesic in China.

Kyle Yang, MBA, is ANANDA Scientific’s China director. He was among the first students from China to attend Harvard. Yang serves as North American representative to China Continuing Medical Education and is a consultant to the China Patent and Trademark Office.