Teetotaling diabetics shouldn't start drinking, despite study's findings
Unknowns remain among alcohol’s apparent cardioprotective effects
No doubt, you already counsel your diabetic patients about alcohol’s hypoglycemic effects, but get ready. Chances are good that more of your diabetic patients are going to be turning to you for advice about drinking alcohol, even patients who aren’t drinkers.
What may prompt the conversations is a study from the University of Wisconsin that found diabetics who reported taking two drinks a day had less than half the chance of dying from heart disease than diabetics who never drink.
Although some patients may be able to offset the hypoglycemic effects by being sure to eat when drinking alcohol, others who have problems regulating their blood glucose may have found it easier not to drink at all.
For these patients, even the Wisconsin researchers say it’s not time to advise they should be consuming alcohol. Nobody knows what happens when people start to drink after having an alcohol-free past — especially when they have diabetes.
"Personally, I wouldn’t recommend any type of drinking," says researcher Ronald Klein, MD, MPH, epidemiologist and professor of ophthalmology and visual sciences at the University of Wisconsin in Madison. "This is not in any way an attempt to justify drinking or to suggest that those who don’t drink should start drinking for health benefits."
He adds that other studies show the rate of stroke is 10% higher among diabetics over 18 who consume fewer than 13 drinks a week than among those who don’t drink. The rate is 13% higher for those over 65.
Investigators selected a cohort of 983 Type 2 diabetics from a pool of more than 10,000 in the Wisconsin Epidemiologic Study of Diabetic Retinopathy, which began in 1980.
Participants all had similar factors in the following categories: age, history of smoking, previous history of myocardial infarction, duration of diabetes, body mass index, blood pressure, HbA1c levels, activity levels, and use of oral agents and/or insulin. (Alcohol consumption was self-reported, and there was no standard amount of alcohol for each drink.)
Klein’s group found the risk of death from heart disease among those who consumed 13 drinks a week or less was 20.8 per 1,000 person-years compared to 43.9 among those who never were drinkers and 38.5 for former drinkers.
While 97% of Klein’s sample group was white, he theorizes that the results he found would likely hold true for other racial groups.
Klein found that those who drank more than an average of two drinks a day seemed to have even greater cardioprotection (10 deaths per 1,000 person-years), but he discounts those results because of the small size of the sample (only 97 individuals). He says he believes the potential for other problems, particularly liver disease, far outweighs any benefits that might be gained from heavy drinking. (See chart, at left.)
But with heart disease accounting for about 40% of all deaths in people with diabetes, the Wisconsin team says its results are worth attention, even though more study is needed. "We found that all relative risks for alcohol drinkers compared with never drinkers still showed lower risk, regardless of disease status," the research team wrote in a paper published July 21 in the Journal of the American Medical Association.
Marion Parrott, MD, vice president for clinical affairs at the American Diabetes Association (ADA) in Arlington, VA, says she also hopes the study will not be used to encourage diabetics to drink. For diabetics who do, the ADA advises they consume no more than two drinks a day for men and one drink a day for women who aren’t pregnant. "Moderation is really the key," she says.
Parrott adds it is important to note that in addition to hypoglycemia, alcohol also can trigger neuropathy and can impair cognition. "One or two drinks a day may be OK, but patients should be advised to use common sense here. If they are drinking moderately, there is no reason why they should stop. They may be doing themselves some good."
"But for someone who is not drinking now, I wouldn’t recommend starting," Parrott says.
She also recommends eating when drinking and reminds diabetic patients, "You have to work it into the meal plan, count the carbohydrates, and think about calories." (See chart from the University of Illinois, p. 99.)
| Alcohol and Calorie Content of Alcoholic Drinks | |||
| Beverage % alcohol by volume | Serving size (ounces) | Alcohol (grams/serving) | Calories (per serving) |
| Wine 11.5% | 4.0 | 11 | 88 |
| Wine cooler 3.5-6% | 12.0 | 10-17 | 220 |
| Beer 4.5% | 12.0 | 13 | 150 |
| Light beer 3.7% | 12.0 | 11 | 100 |
| Gin, vodka, rum, whiskey (80 proof) 40% | 1.5 | 14 | 100 |
| SourceUniversity of Illinois, Urbana | |||
In addition, an editorial in JAMA accompanying Klein’s study cautions against counseling patients to begin drinking if they have never consumed alcohol before or if they cannot restrict their drinking to levels that are light to moderate.
The editorial, written by Michael Criqui, MD, and Beatrice Golomb, MD, of the University of California-San Diego, also states any benefits drinking might give diabetics may be far outweighed by other risks: cancer, liver disease, depression, unintentional injuries, and social discord.
[Contact Ronald Klein at (608) 263-7758 and Marion Parrott at (703) 549-1500.]
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