CME INDIA Presentation by Dr. Richa Manaswita, DGO, DNB(OBG), FGES, Consultant Gynaecologist, Life Care Clinic, Jaipur.

It is a fact that moderate alcohol consumption has been consistently associated with a lower risk for type 2 diabetes. The latest study highlights a unique finding of moderate (about 0.5-1 drink per day) alcohol consumption lowers diabetes risk in women with history of gestational diabetes (GDM) by 41%. How to translate this important finding is a big challenge. Temptation to start alcohol to prevent diabetes in such cases must be refrained.

Why this study is important?

  • This study throws light about women with a history of gestational diabetes and association of habitual alcohol intake with subsequent risk for type 2 diabetes.

What is the risk with history of GDM?

  • Women with a history of gestational diabetes have an especially high risk for type 2 diabetes, with a more than 7-fold increased risk compared with women without a history gestational diabetes.

What type of Study is this?

  • Prospective cohort study of 4740 women with a history of gestational diabetes.
  • Followed up – up to 27 years.
  • Alcohol consumption – 5.0 and 14.9 g/d.
  • Women from the Nurses’ Health Study II cohort were followed who reported a history of gestational diabetes from January 1, 1991, to December 31, 2017.
  • Data analysis has been performed from 2020 to 2021.

What type of Alcohol?

  • Participants consumed (regular and light beer), wine (red and white wine), and liquor.
  • Alcohol consumption (in grams per day) – It was  calculated as the sum of daily drinks multiplied by average alcohol content (beer, 12.8 g/12-oz serving; light beer, 11.3 g/12-oz serving; wine, 11.0 g/4-oz serving; and liquor, 14.0 g/serving).
  • Women with 4 alcohol categories:
    • Women with no alcohol consumption.
    • of 0.1 to 4.9 g/d.
    • Alcohol consumption 5.0 to 14.9 g/d.
    • Alcohol consumption 15.0 g/d or more.

What was found?

  • Alcohol consumption led to 55% lower risk for type 2 diabetes (HR, 0.45; 95% CI, 0.33-0.61) compared with no alcohol consumption.
  • The association was independent of demographic and other major dietary and lifestyle factors.
  • Even when adjustment was done for BMI, alcohol consumption of 5.0 to 14.9 g/d remained associated with a 41% lower risk for type 2 diabetes (HR, 0.59; 95% CI, 0.42-0.81).

What is the bottom line?

  • The context of other known risks must be evaluated. Benefits of alcohol consumption to prevent T2DM in women with history of GDM has been shown but while considering clinical recommendations extreme caution must be taken.

How it can be explained?

  • Increased insulin sensitivity.
  • Anti-inflammatory effects.
  • Increased level of adiponectin, Modulation of adipokine expression.

Do Not Initiate Drinking Alcohol Solely to Reduce Risk for Type 2 Diabetes

Is wine more effective?

  • Previous observational studies have suggested that wine is more strongly associated with a lower risk for type 2 diabetes than beer or liquor.
  • In this study only beer consumption of 1 or more servings per week was associated with lower risk for type 2 diabetes, whereas wine and liquor consumption were not associated with this risk.

No one recommends alcohol to prevent DM

  • Consumption of 0.1 to 14.9 g/d has been associated with improved cardiovascular outcomes and lower all-cause mortality.
  • Consumption levels as low as 5 to 9 g/d have been associated with a modest increase in the risk for breast cancer.
  • So, we must be very careful in balancing of risks and benefits.
  • 2020 Dietary Guidelines for Americans recommend that adults who do not consume alcohol do not initiate drinking.
  • Remember that a single glass of wine can quickly – significantly – raise the drinker’s risk for atrial fibrillation as per a new study, 2021(ref-5). Thus, whenever we consume alcohol, it is presumably having a nearly immediate effect on the electrical workings of our hearts.
  • But another study shows that low consumption of total alcohol up to approximately 7 UK standard drinks (56 g alcohol)/week, equivalent to 4 US standard drinks/week, has been found associated with the lowest risk of atrial fibrillation and low consumption of red and white wine consumption, and very low consumption of spirits, may not be associated with an increased risk of AF; in contrast, any intake of beer or cider may be associated with harm. (Ref-6)
  • It may not be prudent for those with a history of gestational diabetes – who do not consume alcohol – to initiate drinking alcohol solely to reduce their risk for type 2 diabetes.

References

  1. Hinkle SN, Bao W, Wu J, et al. Association of Habitual Alcohol Consumption With Long-term Risk of Type 2 Diabetes Among Women With a History of Gestational Diabetes. JAMA Netw Open. 2021;4(9):e2124669. doi:10.1001/jamanetworkopen.2021.24669
  2. Schrieks IC, Heil AL, Hendriks HF, Mukamal KJ, Beulens JW. The effect of alcohol consumption on insulin sensitivity and glycemic status: a systematic review and meta-analysis of intervention studies. Diabetes Care. 2015;38(4):723-732
  3. Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WAEffect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ 2011;342:d636pmid:21343206
  4. Neuenschwander M, Ballon A, Weber KS, et al. Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies. BMJ. 2019;366:l2368. doi:10.1136/bmj.l2368
  5. Gregory M. Marcus, Eric Vittinghoff, Isaac R. Whitman, Sean Joyce, Vivian Yang, Gregory Nah, Edward P. Gerstenfeld, Joshua D. Moss, Randall J. Lee, Byron K. Lee, Zian H. Tseng, Vasanth Vedantham, Jeffrey E. Olgin, Melvin M. Scheinman, Henry Hsia, Rachel Gladstone, Shannon Fan, Emily Lee, Christina Fang, Kelsey Ogomori, Robin Fatch, Judith A. Hahn. Acute Consumption of Alcohol and Discrete Atrial Fibrillation Events. Annals of Internal Medicine, 2021; DOI: 10.7326/M21-0228
  6. Samuel J. Tu Risk Thresholds for Total and Beverage-Specific Alcohol Consumption and Incident Atrial Fibrillation.J Am Coll Cardiol EP. Jul 27, 2021. Epublished DOI: 10.1016/j.jacep.2021.05.013



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