by Colin Kenny, GP, Dromore
Australian investigators have reassessed data on the effects of alcohol use among participants in ADVANCE (the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation).
ADVANCE recruited more than 11 000 people with diabetes from 20 countries. Alcohol consumption varied within these countries. At baseline, about 30% of participants were alcohol consumers, meaning that there was an adequate number of non-drinkers to act as a control group. Approximately one-third of those who drank reported that more than one-half of their alcohol intake was from wine (median consumption 5 drinks/week) and two-thirds reported that more than one-half of their intake was from beer or spirits (median consumption 7 drinks/week). Unfortunately we do not know about the diets of these individual, which may be a confounder, and self-reported drinking can be unreliable.
The outcomes in this study over 5 years of follow-up were: cardiovascular (CV) events (death from CV disease, non-fatal myocardial infarction, and non-fatal stroke); microvascular disease (renal disease and diabetic eye disease); and all-cause mortality. Over the 5 years, more than 1000 participants had a major CV event. Compared with abstainers, any alcohol use was associated with a 17% lower risk of cardiovascular events, a 15% lower risk of microvascular complications and a 13% lower risk of all-cause mortality. These magnitudes of change were greater than was seen in some of the active treatment arms in the study.
The largest effect on CV events and total mortality was among individuals reporting predominantly consuming wine, rather than beer and spirits. This has led the researchers to conclude that moderate drinkers with diabetes (especially wine drinkers) show a reduced risk of CV events and all-cause mortality. It would appear that we should be supporting moderate consumption of wine in people with diabetes, provided it is combined with food and ideally a Mediterranean-type diet.
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