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Diabetes mellitus is an increasingly-common condition throughout the world, related closely to increases in obesity and ageing of populations. There are many, serious health conditions associated with diabetes, especially a marked increase in the risk of morbidity and mortality from cardiovascular disease.
The latest critique from The ISFAR considers whether to advise diabetics to consume small amounts of alcohol
Scientific data from well-conducted cohort studies have demonstrated for decades that moderate consumers of alcohol tend to have a considerably lower risk of developing diabetes in the first place. Meanwhile, diabetics who consume moderate amounts of alcohol are, in comparison with abstainers, shown to be at much lower risk of developing cardiovascular disease.
A recent 'mini-review' by scientists who have previously carried out the first large randomised clinical trial of wine and health outcomes among diabetics provides an interesting overview of the association of alcohol, particularly of wine, with health.
The authors expand the implications of their research and conclude that "Initiating moderate alcohol consumption among well-controlled persons with Type 2 diabetes is apparently safe, in regard to changes in heart rate variability and carotid plaque formation." Their findings have stimulated this critique by the ISFAR to also consider if available data now suggests that physicians should encourage the modest consumption of wine with food for selected patients with diabetes.
Our critique describes a number of risk factors (lipid levels, glucose, insulin, etc.) and intermediate conditions (such as endothelial function and arterial calcification) that have been shown to relate to the consumption of alcohol. Some ISFAR members believe that while all of these associations are important, the key information needed is the effect of alcohol consumption on disease outcomes themselves (coronary heart disease, stroke, dementia, etc.) and on mortality. At present, any recommendations regarding alcohol consumption must be based primarily on observational data from long-term cohort studies.
The key question discussed in our critique is: "Should physicians advise their older diabetic patients who are non-drinkers to begin to consume small amounts of an alcoholic beverage?" The consensus of ISFAR members is that current data suggests that, at a minimum, we should not advise such patients who currently consume alcohol moderately to stop their consumption. On the other hand, most members emphasise that we should discuss alcohol consumption with all patients. If they are at least occasional consumers of alcohol (the large majority of patients in most Western countries), our only advice might relate to the pattern of drinking. At present, the pattern commonly shown to be associated with the lowest risk of the usual diseases of ageing and mortality appears to be small amounts of alcohol, especially wine, with meals on a regular basis. For patients who indicate that they are drinking only in binges, we should emphasise the adverse health effects (for them as well as for society), and encourage a healthier pattern of drinking.
What about current non-drinkers? For middle-aged or older non-drinkers who avoid alcohol because of religious prohibitions, previous misuse of alcohol, certain medical conditions or a stated dislike of alcohol, our advice on prevention of disease should focus on not smoking, getting exercise, eating a healthy diet, and trying to avoid obesity. For patients without such conditions that would indicate that they should avoid alcohol, however, many ISFAR members believe that they should at least be told of the current scientific evidence of possible beneficial health effects of regular, moderate intake.
Until considerably more data on its effects are available, we are not encouraging physicians to prescribe alcohol consumption for their diabetic patients.
To read the full critique, click here.
These critiques are published with the permission of The International Scientific Forum on Alcohol Research.
Click here for all of the critiques from the International Scientific Forum on Alcohol Research
Sectors: Beer & cider, Corporate social responsibility (CSR), Spirits, Wine
