Drinking Alcohol and Type 2 Diabetes (Adult Onset Diabetes)

The subject of drinking alcohol and type 2 diabetes is important to many diabetics. About six percent of the US population suffers from the disease. Tens of millions of people around the globe have diabetes. Many more are at risk.

              Overview

I.   About Type 2 Diabetes

II.  Research Summaries

III. Form of Alcohol

IV.  Resources

I. About Type 2 Diabetes

Type 2 diabetes is a very serious disease. It’s especially harmful to the kidneys, nerves, and eyes. It can lead to problems such as blindness, impotence, loss of limbs, and death. The disease also increases the risk of heart disease and stroke.

Symptoms

The American Diabetes Association reports that common symptoms of diabetes include these.

• Frequent urination.
• Fatigue
• Strong hunger, athough eating enough.
• Blurry vision.
• Strong thirst.
• Cuts or bruises that are slow to heal.
• Tingling, pain, or numbness in the hands or feet.

Some people have symptoms that are so mild that they go unnoticed. If in doubt, see a doctor.

alcohol and type 2 diabetesBut there’s good news. The moderate consumption of alcohol beverages reduces the risk of getting diabetes. The alcohol can be in the form of beer, wine, liquor or distilled spirits. Spirits include whiskey, tequila, rum, vodka, gin, etc.

II. Research Summaries: Alcohol and Type 2 Diabetes

Moderate drinking is beneficial for type 2 diabetes. The evidence is overwhelming.

A. Reviews of Research

     Of 26 Studies

This meta-analysis examined the dose-response. That is, the link between amount of alcohol consumed and the degree of risk reduction.

The authors analyzed the 26 prospective cohort studies that had the needed data. Included were 706,716 persons (275,711 men and 431,005 women). There were 31,621 cases of diabetes.

Compared to non-drinkers, those who had an average of about one drink per day had a 17% lower risk. Those who had about two drinks per day had a 26% lower risk of the disease. Those who drank more had a 2% lower risk than abstainers.

Researchers adjusted for possible confounders. These were age, sex, BMI (body mass index), smoking, physical activity, and family history of type 2 diabetes. The results were similar in every case.

There was a clear U-shaped curve between drinking alcohol and type 2 diabetes risk. The lowest risk was among both men and women who had an average of about two drinks per day. Alcohol reduces the risk of diabetes. And it does so greatly.1

     Of 20 studies

An analysis of 20 longitudinal cohort studies looked at alcohol and type 2 diabetes risk.

Investigators compared drinkers at different consumption levels to lifetime abstainers. This was to eliminate any possible “sick-quitter” effects.

Lifetime abstainers and heavy drinkers had the greatest risk of type 2 diabetes. Women who had an average of two drinks per day had a 40% reduction in risk for the disease. The beneficial effects of drinking alcohol continued for up to three drinks daily for women.

For men, the risk of type 2 diabetes was lowest among those who consumed about one and one-half drinks daily. The benefits continued for up to four drinks per day.2

     Of 15 studies

alcohol and type 2 diabetesMedical researchers examined the results of 15 different prospective studies. They reported that moderate drinkers were less likely to develop type 2 diabetes than abstainers. Teetotalers and heavy drinkers had equally high risk of the disease.

The 15 studies were in the U.S., Japan, Finland, Korea, the Netherlands, Germany and the UK. They followed a total of 369,862 men and women for an average of 12 years.

Moderate drinkers were those who drank between about a half a drink to four drinks per day. They were 30% less likely to develop type 2 diabetes than abstainers or heavy drinkers. These are much, much higher than US guidelines for drinking.

The pattern of alcohol consumption made a difference. It was much better to drink often (such as daily) rather than infrequently for maximum benefits.3 

     Review of the Literature

Investigators made a major review of the evidence about women. They found that moderate drinking greatly reduced the risk of type 2 diabetes. The disease is a major risk factor for cardiovascular disease. That’s the leading cause of death among women in the US.4 

B. Large Studies

Pre-menopausal women who had a daily drink had a much lower risk of type 2 diabetes than abstainers. The study duplicates similar findings in men. The Harvard study involved about 110,000 women age 25 to 42 over a ten-year period.

Dramatic reductions (about 60%) occurred among women who drank between 1/2 and two drinks daily compared to abstainers. The reduction of risk was lower for those who drank less.5 

Another Harvard study followed 41,810 men 40-75 years old over a period of six years. It controlled for known risk factors. Men who drank higher amounts of alcohol had a reduced risk of diabetes.

Compared to abstainers, men who drank two to three drinks per day had a 39% reduced risk of diabetes. In short, moderate drinking greatly reduces the risk of type 2 diabetes.6 

Researchers studied pairs of twins with different drinking patterns. Those who consumed alcohol in moderation had half the risk of type 2 diabetes compared to those who drank less. The study involved nearly 23,000 twins.7

A study followed almost 21,000 male doctors for over 12 years. Those who were light to moderate drinkers had a lower risk of type 2 diabetes.8

C. Very Long Studies

A study followed 8,663 men over a period as long as 25 years. The incidence of type 2 diabetes was much lower among moderate drinkers. That’s compared to either abstainers or heavy drinkers. These findings persisted after adjusting for possible confounders. They include age, smoking, blood pressure, HDL cholesterol, waist circumference, parental diabetes, and fasting plasma glucose. Also body mass index (BMI), serum triglyceride concentration, and cardiorespiratory fitness.9

A population-based study followed more than 4,000 diabetic and non-diabetic men for 19 years. It compared the effects of drinking alcohol on both cardiovascular and all-cause death.

Moderate drinkers had lower cardiovascular and all-cause death. This was true for diabetic, non-diabetic, and impaired glucose tolerant men.

The decrease in cardiovascular and all-cause death rates with moderate drinking was even greater among diabetics than non-diabetics.10    

D. Other Studies

Insulin

Research in Italy looked at alcohol and type 2 diabetes. It found that drinking directly improved the action of insulin in healthy diabetics. Alcohol also improved fatty acid levels.11

Middle-aged men were in a randomized diet-controlled study. It found that moderate drinking (four drinks of whiskey per day) improved insulin sensitivity in relatively insulin-resistant subjects. They reported that these findings are consistent with other studies.12

alcohol and type 2 diabetesThe New Mexico Elder Health Survey is a cross-sectional community one. Researchers found that alcohol abstainers are more insulin resistant than daily moderate drinkers. This difference may explain the lower prevalence of diabetes in drinkers compared with abstainers.13

Metabolic Syndrome

Metabolic Syndrome refers to a dangerous cluster of conditions that can lead to diabetes and heart disease.

Researchers at Boston Medical Center analyzed data from 8,125 persons in the Third National Health and Nutrition Study. They found that drinkers had a 43 percent lower chance of having Metabolic Syndrome than did non-drinkers.14

Older Women

Non-diabetic postmenopausal women can reduce insulin concentrations and improve insulin sensitivity by consuming alcohol in moderation. This was reported by nutrition researchers at the U.S. Department of Agriculture .

alcohol and type 2 diabetesModerate drinking, compared to abstention, reduced fasting insulin concentration by 19.2%. It lowered triglyceride concentration by 10.3%. And it increased insulin sensitivity by 7.2%. Normal weight, overweight and obese women had similar results. Moderate drinking greatly reduced the risk of type 2 diabetes.15

Women age 40-70 who drank alcohol in moderation had a much lower risk of type 2 diabetes. The large study in the Netherlands followed them for an average of over six years. The “findings support the evidence of a decreased risk of type 2 diabetes with moderate drinking. It expands this to a population of older women.”16

Hyperglycemia

Hyperglycemia is the leading factor linked with diabetes.

Having between about two and four drinks daily greatly reduces the risk of hyperglycemia in obese people. This, in turn, reduces the risk of diabetes. That’s because obesity increases the risk of hypoglycemia. But alcohol reduces the risk of hypoglycemia.

This study confirms that the protective effect of drinking alcohol also applies to obese persons as well.17

Pre-diabetes

alcohol and type 2 diabetesThe Diabetes Prevention Program studied alcohol and type 2 diabetes among pre-diabetics.  It did so at 27 centers throughout the US. The study followed 3,175 pre-diabetic patients. The Program randomly assigned them to experimental and control groups. It then followed them for over three years.

This large study found that moderate drinking may improve insulin secretion. Thus, drinking would prevent the progression of pre-diabetes to diabetes.18

Mediterranean Diet

The Mediterranean Diet emphasizes eating plant-based foods, olive oil, wine in moderation, and low consumption of meat and dairy products.

alcohol and type 2 diabetes

Researchers wanted to know which parts of a Mediterranean Diet most reduced death risk in type 2 diabetes patients. So they scored each of its components.

A total of 1,995 type 2 diabetes patients were followed for four years. Those who more closely followed the Mediterranean Diet were less likely to die during the period.

This information was used to estimate the most important parts of the Mediterranean Diet in promoting longer life. The most valuable was drinking wine in moderation.19

Obesity

alcohol and type 2 diabetesResearch shows that drinking between about two and four drinks daily reduces the risk of hyperglycemia in obese people. This, in turn, reduces the risk of diabetes. That’s because obesity increases the risk of hypoglycemia. But alcohol greatly reduces the risk of hypoglycemia.20

(US guidelines identify one drink per day for women and two drinks per day for men as moderate drinking. This study defines having between about two and four drinks per day as light to moderate. It finds these levels provide health benefits. Government guidelines are somewhat arbitrary. That’s because they are molded by social and political forces.

But doesn’t drinking contribute to weight gain? This common belief is not supported by medical research. See Alcohol, Calories & Weight Gain.

III. Form of Alcoholic Beverage

Clearly, moderate drinkers have a much lower risk of type 2 diabetes than abstainers. Heavy drinkers have an increased risk. It’s as high as that of abstainers. The pattern has the shape of the letter U. But does the U-shaped risk pattern apply to wine, to beer, and to spirits. In other words, does the form of alcoholic beverage matter?

The Study

Researchers conducted a meta-analysis to answer this question. It included 13 studies. Each study examined the effects of specific types of alcoholic beverage on the risk of type 2 diabetes. Together, they provided data on 397,296 study persons and 20,641 cases of the disease.

The Results

alcohol and type 2 diabetesThe meta-analysis found the U-shaped risk pattern for wine, beer, for distilled spirits. Thus, the moderate consumption of any or all of these beverages reduces the risk of type 2 diabetes.21

Summary

Medical research shows that moderate drinking reduces the risk of type 2 diabetes.

The health benefits of moderate drinking are also similar for beer, wine and spirits. The primary factor linked with health and long life is the alcohol itself.

IV. Resources: Alcohol and Type 2 Diabetes

Popular Books

These books don’t focus on alcohol and type 2 diabetes. Instead, they do two things. First, they provide information about type 2 diabetes. Second, they answer questions and provide guidance on managing the disease.

Footnotes
  1. Li, X., et al.   Association between alcohol consumption and the risk of incident type 2 diabetes. Am J Clin Nutr, 2016. DOI: 10.3945/ajcn.115.114389.
  2. Baliunas, D., et al. Alcohol as a risk factor for type 2 diabetes. Diabetes Care, 2009, 32, 2123-2132.
  3. Koppes, L., et al. Moderate alcohol consumption lowers the risk of type 2 diabetes. Diabetes Care, 2005, 28, 719-725.
  4. Bassuk, S. and Manson, J. Lifestyle and risk of cardiovascular disease and type 2 diabetes. Am J Lifestyle Med, 2008, 2(3), 191-213.
  5. Tanner, L. Light to moderate drinking cuts diabetes risk in women, too. Nat Diabetes Info Clearinghouse.
  6. Rimm, E., et al. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes. Brit Med J, 1995, 310, 555-559.
  7. Carlsson, S., et al. Alcohol consumption and the incidence of type 2 diabetes. Diabetes Care, 2003, 26(10), 2785-2786.
  8. Umed, A., et al. Alcohol consumption and risk of type 2 diabetes mellitus. Arch Int Med, 2000, 160, 1025-1050.
  9. Wei, M., et al. Alcohol intake and incidence of type 2 diabetes in men. Diab Care, 2000, 23(1), 18-26.
  10. Nakamura, Y., et al. Alcohol intake and 19-year mortality in diabetic men. Alco, 2009, 43, 635-641.
  11. Avogaro, A., et al. Acute alcohol consumption improves insulin action without affecting insulin secretion in type 2 diabetic subjects. Diab Care, 2004, 27(6), 1369-1374.
  12. Sierkskma, A., et al. Effect of moderate alcohol consumption on adiponectin, tumor necrosis factor-α, and insulin sensitivity. Diab Care, 2004, 27(1), 184-189.
  13. Kenkre, P., et al. Serum insulin concentrations in daily drinkers compared with abstainers.  Bio Sci Med Sci, 2003, 58, M960-M963.
  14. Freiberg, M., et al. Alcohol consumption and the prevalence of the Metabolic Syndrome. Diabetes Care, 2004, 27(11), 2954-2959.
  15. Davies, M., et al. Effects of moderate alcohol intake on fasting insulin and glucose concentrations and insulin sensitivity. JAMA, 2002, 287(19), 2559-2562.
  16. Beulens, J., et al. Alcohol consumption and risk of type 2 diabetes. Diabetes Care, 2005, 28, 2933-2938.
  17. Wakabayashi, U. Light-to-moderate alcohol drinking reduces the impact of obesity on the risk of diabetes mellitus.  J Stud Alco Drugs, 2014, 75, 1032-1038.
  18. Crandall, J., et al. Alcohol consumption and diabetes risk. Am J Clin Nut, 2009, 595-601.
  19. Bonaccio, M., et al. Adherence to the traditional Mediterranean diet and mortality in subjects with diabetes. Euro J Prev Cardiol.  2015. Pre-pub.
  20. Wakabayashi, U.op cit.
  21. Wang, J., et al. Specific types of alcoholic beverage consumption and risk of type 2 diabetes. Diab Investig, 2016 (Epub.)

Notes

The Mediterranean Pyramid by permission of Oldways.

This site gives no advice. Please see a doctor for drinking alcohol and type 2 diabetes concerns.