Advertisement

Alcohol and type 2 diabetes. A review

      Abstract

      Aims

      To describe a) the association between alcohol consumption and the risk of type 2 diabetes (T2D) and b) the impact of alcohol on the glycemic control with and without anti-diabetic drugs.

      Data synthesis

      We searched MEDLINE and the Cochrane Library data base with the key words “Diabetes Mellitus, type 2” and “Alcohol Drinking” in English-language studies in adults. For the first part of the review we selected meta-analyses, review articles and observational studies more recent than year 1990 including at least 1000 participants. For the second part of the review we included all articles more recent than year 1990. Most observational studies find a J-shaped association between alcohol intake and incidence of T2D. Interestingly, drinking pattern plays a role, i.e. binge drinking increases the risk of T2D. Opposing information exists about the influence of beverage type. In T2D the acute effects on plasma glucose, insulin, fatty acids and triglyceride vary, in part depending on concomitant intake of food. Acute alcohol intake does not induce hypoglycemia in diet treated T2D, but increases the risk of hypoglycemia in sulphonylurea treated patients. In most studies, long-term alcohol use is associated with improved glycemic control in T2D.

      Conclusions

      Alcohol consumption reduces the incidence of T2D, however, binge drinking seems to increase the incidence. Acute intake of alcohol does not increase risk of hypoglycemia in diet treated subjects with T2D, only when sulphonylurea is co-administered. Long-term alcohol use seems to be associated with improved glycemic control in T2D probably due to improved insulin sensitivity.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Nutrition, Metabolism and Cardiovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Diabetes Association
        Economic costs of diabetes in the U.S. in 2007.
        Diabetes Care. 2008 Mar; 31: 596-615
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.G.
        • Valle T.T.
        • Hamalainen H.
        • Ilanne-Parikka P.
        • et al.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N Engl J Med. 2001 May 3; 344: 1343-1350
        • Carlsson S.
        • Hammar N.
        • Grill V.
        Alcohol consumption and type 2 diabetes meta-analysis of epidemiological studies indicates a U-shaped relationship.
        Diabetologia. 2005 Jun; 48: 1051-1054
        • Baliunas D.O.
        • Taylor B.J.
        • Irving H.
        • Roerecke M.
        • Patra J.
        • Mohapatra S.
        • et al.
        Alcohol as a risk factor for type 2 diabetes: a systematic review and meta-analysis.
        Diabetes Care. 2009 Nov; 32: 2123-2132
      1. Introduction.
        Diabetes Care. 2004 Jan 1; 27: S1
        • International Center for Alcohol Policies
        (Report 5)
        • Howard A.A.
        • Arnsten J.H.
        • Gourevitch M.N.
        Effect of alcohol consumption on diabetes mellitus: a systematic review.
        Ann Intern Med. 2004 Feb 3; 140: 211-219
        • Koppes L.L.
        • Dekker J.M.
        • Hendriks H.F.
        • Bouter L.M.
        • Heine R.J.
        Moderate alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of prospective observational studies.
        Diabetes Care. 2005 Mar; 28: 719-725
        • Wei M.
        • Gibbons L.W.
        • Mitchell T.L.
        • Kampert J.B.
        • Blair S.N.
        Alcohol intake and incidence of type 2 diabetes in men.
        Diabetes Care. 2000 Jan; 23: 18-22
        • Djousse L.
        • Biggs M.L.
        • Mukamal K.J.
        • Siscovick D.S.
        Alcohol consumption and type 2 diabetes among older adults: the Cardiovascular Health Study.
        Obes (Silver Spring). 2007 Jul; 15: 1758-1765
        • Hu F.B.
        • Manson J.E.
        • Stampfer M.J.
        • Colditz G.
        • Liu S.
        • Solomon C.G.
        • et al.
        Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.
        N Engl J Med. 2001 Sep 13; 345: 790-797
        • Conigrave K.M.
        • Hu B.F.
        • Camargo Jr., C.A.
        • Stampfer M.J.
        • Willett W.C.
        • Rimm E.B.
        A prospective study of drinking patterns in relation to risk of type 2 diabetes among men.
        Diabetes. 2001 Oct; 50: 2390-2395
        • Rimm E.B.
        • Chan J.
        • Stampfer M.J.
        • Colditz G.A.
        • Willett W.C.
        Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men.
        BMJ. 1995 Mar 4; 310: 555-559
        • Ajani U.A.
        • Hennekens C.H.
        • Spelsberg A.
        • Manson J.E.
        Alcohol consumption and risk of type 2 diabetes mellitus among US male physicians.
        Arch Intern Med. 2000 Apr 10; 160: 1025-1030
        • Hodge A.M.
        • English D.R.
        • O’Dea K.
        • Giles G.G.
        Alcohol intake, consumption pattern and beverage type, and the risk of type 2 diabetes.
        Diabet Med. 2006 Jun; 23: 690-697
        • Saremi A.
        • Hanson R.L.
        • Tulloch-Reid M.
        • Williams D.E.
        • Knowler W.C.
        Alcohol consumption predicts hypertension but not diabetes.
        J Stud Alcohol. 2004; 65: 184-190
        • Holbrook T.L.
        • Barrett-Connor E.
        • Wingard D.L.
        A prospective population-based study of alcohol use and non-insulin-dependent diabetes mellitus.
        Am J Epidemiol. 1990 Nov; 132: 902-909
        • Kao W.H.
        • Puddey I.B.
        • Boland L.L.
        • Watson R.L.
        • Brancati F.L.
        Alcohol consumption and the risk of type 2 diabetes mellitus: atherosclerosis risk in communities study.
        Am J Epidemiol. 2001 Oct 15; 154: 748-757
        • Tsumura K.
        • Hayashi T.
        • Suematsu C.
        • Endo G.
        • Fujii S.
        • Okada K.
        Daily alcohol consumption and the risk of type 2 diabetes in Japanese men: the Osaka Health Survey.
        Diabetes Care. 1999 Sep; 22: 1432-1437
        • Seike N.
        • Noda M.
        • Kadowaki T.
        Alcohol consumption and risk of type 2 diabetes mellitus in Japanese: a systematic review.
        Asia Pac J Clin Nutr. 2008; 17: 545-551
        • Goldberg D.M.
        • Soleas G.J.
        • Levesque M.
        Moderate alcohol consumption: the gentle face of Janus.
        Clin Biochem. 1999 Oct; 32: 505-518
        • Facchini F.
        • Chen Y.D.
        • Reaven G.M.
        Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity.
        Diabetes Care. 1994 Feb; 17: 115-119
        • Mayer E.J.
        • Newman B.
        • Quesenberry Jr., C.P.
        • Friedman G.D.
        • Selby J.V.
        Alcohol consumption and insulin concentrations. Role of insulin in associations of alcohol intake with high-density lipoprotein cholesterol and triglycerides.
        Circulation. 1993 Nov; 88: 2190-2197
        • Hendriks H.F.J.
        Moderate alcohol consumption and insulin sensitivity: observations and possible mechanisms.
        Ann Epidemiol. 2007; 17: S40-S42
        • Savolainen M.J.
        • Kesaniemi Y.A.
        Effects of alcohol on lipoproteins in relation to coronary heart disease.
        Curr Opin Lipidol. 1995 Aug; 6: 243-250
        • Hermansen K.
        Diet, blood pressure and hypertension.
        Br J Nutr. 2000 Mar; 83: S113-S119
        • Joosten M.M.
        • Beulens J.W.
        • Kersten S.
        • Hendriks H.F.
        Moderate alcohol consumption increases insulin sensitivity and ADIPOQ expression in postmenopausal women: a randomised, crossover trial.
        Diabetologia. 2008 Aug; 51: 1375-1381
        • Sierksma A.
        • Patel H.
        • Ouchi N.
        • Kihara S.
        • Funahashi T.
        • Heine R.J.
        • et al.
        Effect of moderate alcohol consumption on adiponectin, tumor necrosis factor-(alpha), and insulin sensitivity.
        Diabetes Care. 2004; 27: 184-189
        • Thamer C.
        • Haap M.
        • Fritsche A.
        • Haering H.
        • Stumvoll M.
        Relationship between moderate alcohol consumption and adiponectin and insulin sensitivity in a large heterogeneous population.
        Diabetes Care. 2004 May; 27: 1240
        • Davies M.J.
        • Baer D.J.
        • Judd J.T.
        • Brown E.D.
        • Campbell W.S.
        • Taylor P.R.
        Effects of moderate alcohol intake on fasting insulin and glucose concentrations and insulin sensitivity in postmenopausal women: a randomized controlled trial.
        JAMA. 2002 May 15; 287: 2559-2562
        • Ogge L.E.
        • Gerhard Brohall M.D.
        • Carl J.B.
        • Schmidt C.
        • Fagerberg B.
        Alcohol consumption in relation to metabolic regulation, inflammation, and adiponectin in 64-year-old caucasian women: a population-based study with a focus on impaired glucose regulation.
        Diabetes Care. 2006; 29: 908-913
        • Siler S.Q.
        • Neese R.A.
        • Christiansen M.P.
        • Hellerstein M.K.
        The inhibition of gluconeogenesis following alcohol in humans.
        Am J Physiol. 1998 Nov; 275: E897-E907
        • Lieber C.S.
        Alcohol and the liver: 1984 update.
        Hepatology. 1984 Nov–Dec; 4: 1243-1260
        • Brand-Miller J.C.
        • Fatema K.
        • Middlemiss C.
        • Bare M.
        • Liu V.
        • Atkinson F.
        • et al.
        Effect of alcoholic beverages on postprandial glycemia and insulinemia in lean, young, healthy adults.
        Am J Clin Nutr. 2007 Jun; 85: 1545-1551
        • Koivisto V.A.
        • Tulokas S.
        • Toivonen M.
        • Haapa E.
        • Pelkonen R.
        Alcohol with a meal has no adverse effects on postprandial glucose homeostasis in diabetic patients.
        Diabetes Care. 1993 Dec; 16: 1612-1614
        • Christiansen C.
        • Thomsen C.
        • Rasmussen O.
        • Balle M.
        • Hauerslev C.
        • Hansen C.
        • et al.
        Wine for type 2 diabetic patients?.
        Diabet Med. 1993 Dec; 10: 958-961
        • Christiansen C.
        • Thomsen C.
        • Rasmussen O.
        • Glerup H.
        • Berthelsen J.
        • Hansen C.
        • et al.
        Acute effects of graded alcohol intake on glucose, insulin and free fatty acid levels in non-insulin-dependent diabetic subjects.
        Eur J Clin Nutr. 1993; 47: 648-652
        • Christiansen C.
        • Thomsen C.
        • Rasmussen O.
        • Hauerslev C.
        • Balle M.
        • Hansen C.
        • et al.
        Effect of alcohol on glucose, insulin, free fatty acid and triacylglycerol responses to a light meal in non-insulin-dependent diabetic subjects.
        Br J Nutr. 1994; 71: 449-454
        • Bantle A.E.
        • Thomas W.
        • Bantle J.P.
        Metabolic effects of alcohol in the form of wine in persons with type 2 diabetes mellitus.
        Metabolism. 2008 Feb; 57: 241-245
        • Dalgaard M.
        • Thomsen C.
        • Rasmussen B.M.
        • Holst J.J.
        • Hermansen K.
        Ethanol with a mixed meal decreases the incretin levels early postprandially and increases postprandial lipemia in type 2 diabetic patients.
        Metabolism. 2004 Jan; 53: 77-83
        • Dalgaard M.
        • Thomsen C.
        • Hermansen K.
        Effects of one single bout of low-intensity exercise on postprandial lipaemia in type 2 diabetic men.
        Br J Nutr. 2004 Sep; 92: 469-476
        • Rasmussen B.M.
        • Christiansen C.
        • Rasmussen O.W.
        • Hansen C.
        • Hermansen K.
        Alcohol and postexercise metabolic responses in type 2 diabetes.
        Metab Clin Exp. 1999; 48: 597-602
        • Avogaro A.
        • Watanabe R.M.
        • Dall’Arche A.
        • De Kreutzenberg S.V.
        • Tiengo A.
        • Pacini G.
        Acute alcohol consumption improves insulin action without affecting insulin secretion in type 2 diabetic subjects.
        Diabetes Care. 2004 Jun; 27: 1369-1374
        • Christiansen C.
        • Thomsen C.
        • Rasmussen O.
        • Hansen C.
        • Hermansen K.
        The acute impact of ethanol on glucose, insulin, triacylglycerol, and free fatty acid responses and insulin sensitivity in type 2 diabetes.
        Br J Nutr. 1996 Nov; 76: 669-675
        • Rasmussen B.M.
        • Orskov L.
        • Schmitz O.
        • Hermansen K.
        Alcohol and glucose counter regulation during acute insulin-induced hypoglycemia in type 2 diabetic subjects.
        Metab Clin Exp. 2001; 50: 451-457
        • Avogaro A.
        • Beltramello P.
        • Gnudi L.
        • Maran A.
        • Valerio A.
        • Miola M.
        • et al.
        Alcohol intake impairs glucose counterregulation during acute insulin-induced hypoglycemia in IDDM patients. Evidence for a critical role of free fatty acids.
        Diabetes. 1993 Nov; 42: 1626-1634
        • Banini A.E.
        • Boyd L.C.
        • Allen J.C.
        • Allen H.G.
        • Sauls D.L.
        Muscadine grape products intake, diet and blood constituents of non-diabetic and type 2 diabetic subjects.
        Nutrition. 2006 Nov–Dec; 22: 1137-1145
        • Zunino S.
        Type 2 diabetes and glycemic response to grapes or grape products.
        J Nutr. 2009 Sep; 139: 1794S-1800S
        • Ben G.
        • Gnudi L.
        • Maran A.
        • Gigante A.
        • Duner E.
        • Iori E.
        • et al.
        Effects of chronic alcohol intake on carbohydrate and lipid metabolism in subjects with type II (non-insulin-dependent) diabetes.
        Am J Med. 1991 Jan; 90: 70-76
        • Ahmed A.T.
        • Karter A.J.
        • Warton E.M.
        • Doan J.U.
        • Weisner C.M.
        The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Diabetes Registry.
        J Gen Intern Med. 2008 Mar; 23: 275-282
        • Shai I.
        • Wainstein J.
        • Harman-Boehm I.
        • Raz I.
        • Fraser D.
        • Rudich A.
        • et al.
        Glycemic effects of moderate alcohol intake among patients with type 2 diabetes: a multicenter, randomized, clinical intervention trial.
        Diabetes Care. 2007 Dec; 30: 3011-3016
        • Burge M.R.
        • Zeise T.-
        • Sobhy T.A.
        • Rassam A.G.
        • Schade D.S.
        Low-dose ethanol predisposes elderly fasted patients with type 2 diabetes to sulfonylurea-induced low blood glucose.
        Diabetes Care. 1999; 22: 2037-2043
        • Burge M.R.
        • Sood V.
        • Sobhy T.A.
        • Rassam A.G.
        • Schade D.S.
        Sulphonylurea-induced hypoglycaemia in type 2 diabetes mellitus: a review.
        Diabetes Obes Metab. 1999 Jul; 1: 199-206
        • Foot E.A.
        • Eastmond R.
        Good metabolic and safety profile of troglitazone alone and following alcohol in NIDDM subjects.
        Diabetes Res Clin Pract. 1997; 38: 41-51
        • Richardson T.
        • Weiss M.
        • Thomas P.
        • Kerr D.
        Day after the night before: influence of evening alcohol on risk of hypoglycemia in patients with type 1 diabetes.
        Diabetes Care. 2005 Jul; 28: 1801-1802
        • Cheyne E.H.
        • Sherwin R.S.
        • Lunt M.J.
        • Cavan D.A.
        • Thomas P.W.
        • Kerr D.
        Influence of alcohol on cognitive performance during mild hypoglycaemia; implications for type 1 diabetes.
        Diabet Med. 2004 Mar; 21: 230-237
      2. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association.
        Diabetes Care. 2008; 31: S61-S78
        • Mann J.I.
        • De Leeuw I.
        • Hermansen K.
        • Karamanos B.
        • Karlstrom B.
        • Katsilambros N.
        • et al.
        Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus.
        Nutr Metab Cardiovasc Dis. 2004 Dec; 14: 373-394
        • Carlsson S.
        • Hammar N.
        • Grill V.
        • Kaprio J.
        Alcohol consumption and the incidence of type 2 diabetes: a 20-year follow-up of the Finnish twin cohort study.
        Diabetes Care. 2003 Oct; 26: 2785-2790
        • Crandall J.P.
        • Polsky S.
        • Howard A.A.
        • Perreault L.
        • Bray G.A.
        • Barrett-Connor
        • et al.
        Diabetes Prevention Program Research Group. Alcohol consumption and diabetes risk in the Diabetes Prevention Program.
        Am J Clin Nutr. 2009 Sep; 90: 595-601
        • de Vegt F.
        • Dekker J.M.
        • Groeneveld W.J.
        • Nijpels G.
        • Stehouwer C.D.
        • Bouter L.M.
        • et al.
        Moderate alcohol consumption is associated with lower risk for incident diabetes and mortality: the Hoorn Study.
        Diabetes Res Clin Pract. 2002 Jul; 57: 53-60
        • Gurwitz J.H.
        • Field T.S.
        • Glynn R.J.
        • Manson J.E.
        • Avorn J.
        • Taylor J.O.
        • et al.
        Risk factors for non-insulin-dependent diabetes mellitus requiring treatment in the elderly.
        J Am Geriatr Soc. 1994 Dec; 42: 1235-1240
        • Lu W.
        • Jablonski K.A.
        • Resnick H.E.
        • Jain A.K.
        • Jones K.L.
        • Gottlieb A.M.
        • et al.
        Alcohol intake and glycemia in American Indians: the strong heart study.
        Metabolism. 2003 Feb; 52: 129-135
        • Nakanishi N.
        • Suzuki K.
        • Tatara K.
        Alcohol consumption and risk for development of impaired fasting glucose or type 2 diabetes in middle-aged Japanese men.
        Diabetes Care. 2003 Jan; 26: 48-54
        • Wannamethee S.G.
        • Shaper A.G.
        • Perry I.J.
        • Alberti K.G.
        Alcohol consumption and the incidence of type II diabetes.
        J Epidemiol Community Health. 2002 Jul; 56: 542-548
        • Wannamethee S.G.
        • Camargo Jr., C.A.
        • Manson J.E.
        • Willett W.C.
        • Rimm E.B.
        Alcohol drinking patterns and risk of type 2 diabetes mellitus among younger women.
        Arch Intern Med. 2003 Jun 9; 163: 1329-1336
        • Wei M.
        • Gibbons L.W.
        • Mitchell T.L.
        • Kampert J.B.
        • Blair S.N.
        Alcohol intake and incidence of type 2 diabetes in men.
        Diabetes Care. 2000 Jan; 23: 18-22