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EASD: Moderate Wine Drinking Lowers Fasting Glucose in Type 2 Diabetes

Sep 28, 2010

A glass of merlot or perhaps sauvignon blanc with dinner may offer modest benefits for patients with Type 2 diabetes, said researchers….

In a small study, diabetic patients who drank tea agreed to drink a 150 mL (five ounce) glass of wine with dinner daily for three months and had modest but significant reductions (P=0.015) in fasting plasma glucose compared with controls who drank non-alcoholic diet beer, reported Iris Shai, Ph.D., of Ben Gurion University in Beer-Sheva, Israel, and colleagues.

Dr. Shai reported at the EASD meeting that alcohol did not, however, have any significant effects on post-meal glucose levels.

“Meta-analysis of observational studies suggests that moderate alcohol is associated with a lower risk of coronary heart disease mortality among patients with Type 2 diabetes,” Dr. Shai said, “and this beneficial effect is greater than among non-diabetics.”

She noted that several short term studies reported decreases in fasting plasma glucose associated with alcohol consumption in patients with diabetes, but others found no significant effect.

To help clarify the situation, the authors recruited 109 abstemious patients with confirmed Type 2 diabetes ages 41 to 74.

The patients were randomized in a 2:1 ratio to receive 150 mL of wine — either a merlot, for those who expressed a preference for red wine, or a sauvignon blanc, for those who wanted white — or a non-alcoholic diet malt beer (0 g alcohol, 30 calories) to be taken with dinner for three months. The patients were provided standardized glasses for their assigned beverage.

A total of 91 patients completed the study, with significantly more dropouts occurring in the control group than in the intervention group. All participants received individual diet and nutritional counseling, but were not pushed to lose weight. Diet and alcohol consumption were monitored in the study. “

They found that among the wine drinkers, fasting plasma glucose decreased from 139.58 mg/dL + 41.0 to 118.01 + 32.5 after three months, but there was no similar change among controls (Delta = -21.55mg/dL, P=0.015 compared with the delta of controls).

Alcohol consumption did not have an effect, however, on two-hour post-prandial glucose levels (P=0.966).

Among the wine drinkers, those with higher baseline HbA1c levels had a greater reduction in fasting plasma glucose (age-adjusted correlation -0.33, P=0.045).

There were no significant hepatic effects of introducing alcohol to previous non-drinkers, as evidenced by measures of serum bilirubin, alkaline phosphatase, alanine aminotransferase (ALT), or aspartate aminotransferase (AST).

When asked about possible adverse effects, new wine drinkers reported no significant changes from baseline compared with controls, except for an improved ability to fall asleep.

Dr. Shai said that the effects of ethanol may be similar to that of metformin, which inhibits hepatic glucose production.

“We are discussing a lot what drives the beneficial effects of wine,” Dr. Shai replied. “We’re not sure if it’s the ethanol or the other components of the red wine … but in the future if we compared only red wine to controls, we would never know if it was the ethanol or the other components.” Red wine is high in flavanols and catechines, both of which have beneficial metabolic effects, but white wine is not.

Practice Pearls:
  • Explain to patients that the study was small, and that further study is needed to determine whether the effects the authors saw would hold up in a larger population.
  • Note, too, that the study was published as an abstract and presented at a conference. The data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Shai I et al. “Effect of moderate alcohol intake on patients with Type 2 diabetes; multi-center, randomised, diet-controlled intervention study.” Abstract 0147, presented Sept. 20.