Can alcohol consumption cause diabetes mellitus (DM)?

Alcohol Consumption and Diabetes Mellitus

Heavy or excessive alcohol consumption can cause deterioration in glucose metabolism and increase the risk of developing type 2 diabetes, while light-to-moderate consumption may actually decrease risk. 1

Effects of Alcohol on Diabetes Risk

• Chronic heavy alcohol ingestion (≥45 g/day or ≥3 drinks/day) causes deterioration in both long-term and short-term glucose metabolism, potentially leading to the development of type 2 diabetes 1

• Light-to-moderate alcohol consumption (1-2 drinks/day or 5-15 g/day) is associated with a decreased risk of developing type 2 diabetes in nondiabetic individuals, with studies showing a 33-56% lower incidence 1, 2

• The relationship between alcohol and diabetes risk appears to be J-shaped, with both abstention and heavy consumption associated with higher risk than moderate consumption 3, 2

• Gender differences exist in alcohol's effects on diabetes risk:

  • In men, total alcohol consumption and binge drinking increase the risk of pre-diabetes and type 2 diabetes 3
  • In women, low consumption decreases diabetes risk, while high consumption increases it 3, 4

Mechanisms of Alcohol's Effects on Glucose Metabolism

• Alcohol can have both hypoglycemic and hyperglycemic effects depending on:

  • Amount consumed
  • Whether consumed with or without food
  • Whether use is chronic/excessive 1

• Moderate amounts of alcohol can enhance the glucose-lowering action of insulin and certain oral glucose-lowering medications by interfering with hepatic gluconeogenesis 1

• Alcohol-induced hypoglycemia is not ameliorated by glucagon because it impairs gluconeogenesis rather than being associated with excessive insulin secretion 1

• Chronic excessive alcohol use can lead to:

  • Insulin resistance
  • Pancreatic β-cell dysfunction
  • Disruption of glucose homeostasis 5

Beverage-Specific Effects

• Different alcoholic beverages may have varying effects on diabetes risk:
  • In men, high beer consumption increases pre-diabetes risk, while high spirits consumption increases type 2 diabetes risk 3
  • In women, wine consumption is associated with reduced risk of pre-diabetes, while moderate intake of both wine and spirits is linked to reduced diabetes risk 3, 4
  • High spirits consumption increases pre-diabetes risk in women 3

Clinical Implications and Recommendations

• For people who choose to drink alcohol:

  • Intake should be limited to moderate amounts: ≤1 drink/day for women and ≤2 drinks/day for men 1
  • One alcoholic beverage is defined as 12 oz beer, 5 oz wine, or 1.5 oz distilled spirits, each containing approximately 15 g of alcohol 1

• For individuals with diabetes who use insulin or insulin secretagogues:

  • Alcohol should be consumed with food to avoid hypoglycemia 1
  • Evening consumption increases risk of nocturnal and fasting hypoglycemia, particularly in type 1 diabetes 1

• Abstention from alcohol is advised for:

  • People with history of alcohol abuse/dependence
  • Women during pregnancy
  • People with medical conditions such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia 1

Important Caveats and Pitfalls

• Alcohol can blunt awareness of hypoglycemia in people with type 1 diabetes, increasing risk of severe episodes 1

• Excessive alcohol (≥3 drinks/day) consumed consistently contributes to hyperglycemia 1

• The effects of excessive alcohol consumption on glucose metabolism can be reversed after 3 days of abstinence 1

• Alcohol potentiates the effect of metformin on lactate metabolism, potentially increasing the risk of lactic acidosis 6

• Frequency of consumption matters - more frequent consumption (at least 5 days/week) may provide greater protection against diabetes development, even with low amounts per drinking day 7