The Relationship Between Alcohol Consumption and Glycemic Control Among Patients with Diabetes: The Kaiser Permanente Northern California Diabetes Registry

Kaiser Permanente Division of Research, Oakland, CA 94612, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 03/2008; 23(3):275-82. DOI: 10.1007/s11606-007-0502-z
Source: PubMed


Alcohol consumption is a common behavior. Little is known about the relationship between alcohol consumption and glycemic control among people with diabetes.
To evaluate the association between alcohol consumption and glycemic control.
Survey follow-up study, 1994-1997, among Kaiser Permanente Northern California members.
38,564 adult diabetes patients.
Self-reported alcohol consumption, and hemoglobin A1C (A1C), assessed within 1 year of survey date. Linear regression of A1C by alcohol consumption was performed, adjusted for sociodemographic variables, clinical variables, and diabetes disease severity. Least squares means estimates were derived.
In multivariate-adjusted models, A1C values were 8.88 (lifetime abstainers), 8.79 (former drinkers), 8.90 (<0.1 drink/day), 8.71 (0.1-0.9 drink/day), 8.51 (1-1.9 drinks/day), 8.39 (2-2.9 drinks/day), and 8.47 (>/=3 drinks/day). Alcohol consumption was linearly (p < 0.001) and inversely (p = 0.001) associated with A1C among diabetes patients.
Alcohol consumption is inversely associated with glycemic control among diabetes patients. This supports current clinical guidelines for moderate levels of alcohol consumption among diabetes patients. As glycemic control affects incidence of complications of diabetes, the lower A1C levels associated with moderate alcohol consumption may translate into lower risk for complications.

Download full-text


Available from: Margaret Warton, May 22, 2015
  • Source
    • "Moderate alcohol consumption has minimal detrimental acute and/or long-term effects on blood glucose in people with diabetes. Studies of alcohol consumption in persons with diabetes report a U-shaped or J-shaped association, suggesting a benefit from moderate consumption.39,40 Moderate consumption in people with type 2 diabetes is also reported to be associated with a reduced risk of and mortality from coronary heart disease and lower total mortality rates,41 likely related to improved insulin sensitivity.42 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Current nutrition therapy recommendations for the prevention and treatment of diabetes are based on a systematic review of evidence and answer important nutrition care questions. First, is diabetes nutrition therapy effective? Clinical trials as well as systematic and Cochrane reviews report a ~1%-2% lowering of hemoglobin A1c values as well as other beneficial outcomes from nutrition therapy interventions, depending on the type and duration of diabetes and level of glycemic control. Clinical trials also provide evidence for the effectiveness of nutrition therapy in the prevention of diabetes. Second, are weight loss interventions important and when are they beneficial? Modest weight loss is important for the prevention of type 2 diabetes and early in the disease process. However, as diabetes progresses, weight loss may or may not result in beneficial glycemic and cardiovascular outcomes. Third, are there ideal percentages of macronutrients and eating patterns that apply to all persons with diabetes? There is no ideal percentage of macronutrients and a variety of eating patterns has been shown to be effective for persons with diabetes. Treatment goals, personal preferences (eg, tradition, culture, religion, health beliefs, economics), and the individual's ability and willingness to make lifestyle changes must all be considered by clinicians and/or educators when counseling and educating individuals with diabetes. A healthy eating pattern emphasizing nutrient-dense foods in appropriate portion sizes, regular physical activity, and support are priorities for all individuals with diabetes. Reduced energy intake for persons with prediabetes or type 2 diabetes as well as matching insulin to planned carbohydrate intake are intervention to be considered. Fourth, is the question of how to implement nutrition therapy interventions in clinical practice. This requires nutrition care strategies.
    Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 02/2014; 7:65-72. DOI:10.2147/DMSO.S45140
  • Source
    • "Studies among both diabetics and nondiabetics demonstrate a J-or U-shaped curve between alcohol consumption and insulin sensitivity (Bell et al. 2000; Davies et al. 2002; Greenfield et al. 2003; Kroenke et al. 2003). Likewise, two large epidemiologic studies among diabetic subjects show that moderate alcohol consumption is associated with better glycemic control (Ahmed et al. 2008; Mackenzie et al. 2006). An important limitation of these studies, however, is that few included ethnic minority groups or failed to emphasize possible differences in relation to ethnicity in their analyses. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Alcohol consumption is differentially associated with social and health harms across U.S. ethnic groups. Native Americans, Hispanics, and Blacks are disadvantaged by alcohol-attributed harms compared with Whites and Asians. Ethnicities with higher rates of risky drinking experience higher rates of drinking harms. Other factors that could contribute to the different effects of alcohol by ethnicity are social disadvantage, acculturation, drink preferences, and alcohol metabolism. This article examines the relationship of ethnicity and drinking to (1) unintentional injuries, (2) intentional injuries, (3) fetal alcohol syndrome (FAS), (4) gastrointestinal diseases, (5) cardiovascular diseases, (6) cancers, (7) diabetes, and (8) infectious diseases. Reviewed evidence shows that Native Americans have a disproportionate risk for alcohol-related motor vehicle fatalities, suicides and violence, FAS, and liver disease mortality. Hispanics are at increased risk for alcohol-related motor vehicle fatalities, suicide, liver disease, and cirrhosis mortality; and Blacks have increased risk for alcohol-related relationship violence, FAS, heart disease, and some cancers. However, the scientific evidence is incomplete for each of these harms. More research is needed on the relationship of alcohol consumption to cancers, diabetes, and HIV/AIDS across ethnic groups. Studies also are needed to delineate the mechanisms that give rise to and sustain these disparities in order to inform prevention strategies.
    Alcohol research : current reviews 11/2013; 35(2):229-37.
  • Source
    • "However, other factors such as gender, educational status, type of diabetes (Table 2) alcohol drinking, cigarette smoking, and duration on insulin treatment (Table 3) did not show correlation with poor glycemic control. In the present study alcohol intake and cigarette smoking were not identified as risk factors, a finding that can be explained as most of the patients use to drink alcohol or smoke cigarette for refreshment habit and moderate alcohol consumption has been reported to enhance insulin sensitivity and improve glycemic control [13]. Other studies showed that cigarette smoking by diabetic patients is associated with an increased prevalence of microvascular complications, at least partly mediated through poor glycemic control [14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Good glycemic control reduces the risk of diabetic complications. Despite this, achieving good glycemic control remains a challenge in diabetic patients. The objective of this study is to identify determinants of glycemic control among insulin treated diabetic patients at Jimma University Hospital, Southwest Ethiopia. Hospital-based cross-sectional study was conducted on systematically sampled 284 insulin-treated diabetic patients with a regular follow up. Data was collected by interviewing patients during hospital visits and reviewing respective databases of September 2010 to December 2011. Data collection took place from February 20 to May 20, 2012. Poor glycemic control was defined as fasting blood sugar (FBS) ≥126 mg/dL. Binary logistic regression analysis was conducted to identify predictors of poor glycemic control. Patients had a mean age of 41.37 (±15.08) years, 58.5% were males, the mean duration of insulin treatment was 4.9 (±5.1) years, 18.3% achieved good glycemic control (FBS≤126 mg/dL), 95% self-reported repeated use of disposable insulin syringe-needle and 48% correctly rotating insulin injection sites. Most (83.1%) of study participants had one or more complications. On multivariable logistic regression analyses, body weight of >70 Kg (AOR = 0.21; P<0.001), total daily dose of insulin ≤35 IU/day (AOR = 0.26; P<0.001), total daily dose variation without checking glycemic level (AOR = 3.39; P = 0.020), knowledge deficit about signs and symptoms of hyperglycemia (AOR = 3.60; P = 0.004), and non-adherence to dietary management (AOR = 0.35; P = 0.005) were independent predictors of poor glycemic control. The proportion of patients with poor glycemic control was high, which resulted in the development of one or more complications regardless of duration on insulin treatment. Hence, appropriate management of patients focusing on the relevant associated factors and independent predictors of poor glycemic control would be of great benefit in glycemic control.
    PLoS ONE 04/2013; 8(4):e61759. DOI:10.1371/journal.pone.0061759 · 3.23 Impact Factor
Show more