What’s the association between diabetes and alcohol?
Diabetes is defined as a group of diseases characterized by high blood glucose levels that result from the body’s inability to produce and/or use insulin. Consistent uncontrolled blood sugar levels can lead to a wide range of other comorbidities to develop such as vision loss, kidney failure, cardiovascular events, amputations, gastric issues, sexual dysfunction, etc.
According to a study published in Healio, around 98 percent of American adults with type 2 diabetes have at least one comorbid condition while around 90 percent have two comorbidities. After a retrospective analysis of electronic health records, researchers discovered the most common comorbid conditions in these adults were hypertension, overweight or obesity, and hyperlipidemia.
Factors that increase the risk for developing diabetes include being overweight, a lack of exercise, and a family history of the disease, but what about diabetes and alcohol? Alcohol as a contribution to diabetes has been a highly discussed topic within the medical community. Alcohol can be high in caloric content, especially beers and mixed drinks that are high in carbohydrates. Like many other sugary and fattening foods, alcohol can certainly lead to becoming overweight or developing obesity. There have been many studies that have been conducted meant to access the effect of alcohol consumption on diabetes – some suggesting that a moderate intake contributes to the risk for diabetes, and others suggesting moderate alcohol is a protective for type 2 diabetes.
The association between diabetes and alcohol
A study from Diabetes Care sought to clarify the dose-response relationship between alcohol consumption and type two diabetes. Results from 20 cohort studies found a U-shape relationship for both male and females. For men, the relative risk for type 2 diabetes was most protective when consuming 22g/d of alcohol and for women, RR for type 2 diabetes was most protective when consuming 24g/day.
Interestingly, back in 2008, researchers performed a cohort study looking at a group of 70,000 people to see if there was an association between moderate, frequent alcohol consumption and a reduced risk of developing either type 1 or type 2 diabetes. This study was conducted using a survey which asked participants about their health and lifestyle between 2007 and 2008. These questions pertained to drinking habits and participants were required to have: no existing diagnosis of diabetes at the start of the study, no pregnancy or given birth within the last six months, and provide some degree of information about drinking patterns. Four years later, in 2012, researchers checked back with the participants to see if they had developed type 1 or type 2 diabetes.
A pattern was discovered and suggested that people who did develop diabetes were less likely to have consumed alcohol moderately and frequently compared to those who did not develop diabetes. During the study, 1,746 people developed diabetes (859 men, 887 women) and lowest risk of diabetes among these two gender groups were:
- Men who drank 14 drinks a week
- Women who drank 9 drinks a week
Based on these results, researchers concluded, “light to moderate” consumption of alcohol was associated with a lower risk of diabetes compared to absolutely no consumption of alcohol.
The last word on diabetes and alcohol?
While the study above was strong in that it was very large and cohort, in 2017, the National Library of Medicine commented that this study had more than just a few limitations, therefore weakening the reliability of an association between moderate, frequent alcohol consumption and a lower risk of diabetes:
- First, drinking habits as well as other risk factors were only asked of participants at a single point in time. So this particular study failed to explain whether habits reported then had changed over the period of time in which people were monitored for diabetes. Also, answers to alcohol consumption related questions do run the risk of being inaccurate due to people not describing their drinking habits correctly.
- Second, this study failed to distinguish between type 1 and type 2 diabetes. This is important because type 1 and type 2 differ in their causes as well as their treatment.
- Third, a condition like diabetes is likely to develop due to risk factors experienced during a long period of time. While this study’s follow-up time was almost five years, this is not a long enough period of time for purposes of this study.
- Four, it is possible the data collected on diet may have been too simple to properly understand the impact nutrition may contribute to the risk of diabetes on people in this study.
- Lastly, while people were excluded from this study who already had diabetes at baseline, people with other chronic health conditions were not excluded, some of which may be contributing factors to the risk for diabetes.
Another notable study was published in 2015 and assessed the relationship between alcohol consumption and the risk for type 2 diabetes. This vast study contained data from more than 1.9 million individuals from 38 observational studies that met selection criteria.
The objective of this meta-analysis was to gather clearer information on whether moderate alcohol consumption reduces the risk of type 2 diabetes and whether this assumption is due to misclassification bias – error in measurement.
The result of this study reported from researchers was the following: “Relative to combined abstainers, reductions in the risk of type 2 diabetes were present at all levels of alcohol intake <63 g/day, with risks increasing above this threshold. Peak risk reduction was present between 10–14 g/day at an 18% decrease in hazards.”
Diabetes and alcohol: where to go from here?
Critics say that while an association between moderate, frequent amounts of alcohol and a lower risk for type 2 diabetes may exist, far healthier methods to reduce the risk for type 2 diabetes exist, such as a healthy diet, exercise and controlling blood glucose levels.
Gary Scheiner, an award-winning Certified Diabetes Educator, has provided a guideline for people with diabetes on an insulin pump who wish to drink alcohol and suggests that the basal rate be reduced by 30-50 percent for 2 hours for each alcoholic drink. So, for instance, if a person with diabetes has had three alcoholic beverages, he or she should set this temp basal rate for six hours.
Understanding other risk factors to the development of diabetes, such as obesity and a lack of exercise, are crucial for preventing the risk of developing this condition. Moreover, while some studies, like those mentioned above, do show an association between alcohol consumption and a reduced risk of diabetes, drinking alcohol can contribute to other health conditions such as liver disease and cancers.
More on diabetes and alcohol:
- http://care.diabetesjournals.org/content/26/10/2785 – Alcohol Consumption and the Incidence of Type 2 Diabetes
- http://www.diabetologia-journal.org/files/Holst.pdf – Alcohol drinking and risk of diabetes: a cohort study of 70,551 men and women from the general Danish population
- https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/news/2017-07-28-reports-that-frequent-drinking-prevents-diabetes-are-inaccurate/ Reports that frequent drinking prevents diabetes are inaccurate
- https://mysugr.com/diabetes-and-alcohol/ Garry Scheiner – award-winning Certified Diabetes Educator – offering guideline for insulin pump users. Basal rates