Moderate Alcohol Intake Reduces Fasting Glucose

In patients with type 2 diabetes, moderate daily intake of alcohol reduced fasting plasma glucose (FPG) but not postprandial glucose, especially in those with high levels of glycated hemoglobin. "In observational studies, moderate alcohol intake is associated with lower incidence of type 2 diabetes. Also, a recent meta-analysis of patients with type 2 diabetes suggests that moderate alcohol consumption is associated with a lower risk of mortality and coronary heart disease (CHD).""Proving the beneficial effect of moderate alcohol intake .

In this 3-month, multicenter trial, 109 alcohol-abstaining patients with established type 2 diabetes were randomized to receive 150 mL of wine (13 g alcohol) or nonalcoholic diet beer (control) daily during dinner. Age range was 41 to 74 years. Diet and alcohol consumption were monitored during the trial.

Of the 109 participants who were randomized, 17% (12% from the alcohol group) dropped out, leaving 91 who completed the study. After 3 months, FPG decreased from 139.6 ± 41 to 118.0 ± 32.5 mg/dL in the alcohol group vs 136.7 ± 15.4 to 138.6 ± 27.8 mg/dL in the control group (P = .015).

Alcohol consumption was not associated with any effect on 2-hour postprandial glucose levels (difference = 18.5 in the control group vs 17.7 mg/dL in the alcohol group; P = .97). In the alcohol group, patients with higher hemoglobin A1c levels at baseline had greater decreases in FPG (age-adjusted correlation = –0.57; P < .001).

There were no apparent adverse effects, and no significant changes in bilirubin, alkaline phosphatase, alanine aminotransferase (ALT), or aspartate aminotransferase (AST) levels. In the alcohol group, participants noted improved ability to fall asleep (P < .001).

"Among previous alcohol abstainers with type 2 diabetes, initiation of moderate daily alcohol consumption reduced FPG but not postprandial glucose," the authors write. "Patients with higher HbA1c [hemoglobin A1c] may benefit more from the favorable glycemic effect of alcohol. Further intervention studies are needed to confirm the long-term effect of moderate alcohol intake."

"In doses shown in epidemiology to confer CVD [cardiovascular disease] and glycemic benefits, not all metabolic changes attributed to alcohol can be captured within 3 months in patients with type 2 diabetes," the authors conclude. "Longer intervention studies are needed to determine the long-term efficacy and safety of initiating moderate alcohol intake among abstainers with type 2 diabetes, with assessment of clinical or intermediate outcomes."

Practice Pearl: After 3 months of consuming 1 drink daily, FPG levels decreased significantly by 9.2% in the alcohol group vs a nonsignificant change in the controls. Alcohol consumption did not affect 2-hour postprandial glucose levels. In the alcohol group, patients with higher hemoglobin A1c levels at baseline had greater decreases in FPG levels.

Diabetes Care. Published online September 11, 2007.

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