Alcohol consumption and risk of microvascular complications in type 1 diabetes patients: the EURODIAB Prospective Complications Study

Abstract

Aims/hypothesis The aim of this study was to investigate the association between alcohol consumption and risk of microvascular complications (retinopathy, neuropathy, nephropathy) in type 1 diabetes mellitus patients in the EURODIAB Prospective Complications Study. Methods The EURODIAB Prospective Complications Study is a follow-up study including 3,250 type 1 diabetes mellitus patients from 16 different European countries. We investigated the cross-sectional association between moderate alcohol consumption and risk of retinopathy, neuropathy and nephropathy among 1,857of these patients. Results We documented 304 cases of proliferative retinopathy, 660 cases of neuropathy and 157 cases of nephropathy (macroalbuminuria). Alcohol consumption was associated with risk of proliferative retinopathy, neuropathy and macroalbuminuria in a U-shaped fashion. Moderate consumers (30-70 g alcohol per week) had a lower risk of microvascular complications with odds ratios of 0.60 (95% CI 0.37-0.99) for proliferative retinopathy, 0.61 (0.41-0.91) for neuropathy and 0.36 (0.18-0.71) for macroalbuminuria in multivariate-adjusted models. These results were similar when excluding patients who had been advised to drink less alcohol because of their health. The relation was most pronounced for alcohol consumption from wine. Drinking frequency was significantly, inversely associated with risk of neuropathy, but a similar trend was visible for proliferative retinopathy and macroalbuminuria. Alcohol consumption was not associated with occurrence of ketoacidosis or hypoglycaemic attacks. Conclusions/interpretation Consistent with its effects on macrovascular complications, moderate alcohol consumption is associated with a lower risk of all microvascular complications among type 1 diabetes patients.

Alcohol Consumption, but Not Physical Activity or Smoking, Contribute To Advanced Forms of Diabetic Retinopathy: A Case-Control Study

“…some of the studies were cross-sectional and others longitudinal. Some studies, such as Xu et al [12] and Giuffre et al [14] are based on prevalence or duration of alcohol consumption while others report amounts of absolute alcohol consumed [13,15]. However, the classification of amount of alcohol consumption between studies varied considerably, and in most of them including current study, the type of alcohol being consumed has not been taken into account.…”

“…The association of alcohol and diabetic retinopathy does not seem to be straight-forward, since there is evidence for a U-shaped curve in the relationship between alcohol consumption and proliferative diabetic retinopathy [15], i.e. moderate drinkers are at a lower risk (OR 0.60, 95% CI 0.37-0.99) compared with heavy drinkers or abstainers Pseudo R square (Nagelkerke) was 0.366. with the association being most significant in wine drinkers.…”

“…that affect lipid oxidation. Besides the type of beverage consumed, the influence of alcohol consumption on the risk of diabetic retinopathy could be moderated through several mechanisms including the ability of alcohol consumption to increase plasma HDL cholesterol [10,23] even though adjustment for HDL did not affect the association of alcohol with retinopathy [15]. Furthermore, reduced platelet aggregation and especially the U-shaped association of alcohol with the plasma fibrinogen concentration [24] highlight the importance of several vascular factors which also influence diabetic retinopathy [10].…”

“…Physical activity differed also between diabetes types, i.e. 50 % whereas Beulens reported a protective effect of alcohol against any type of diabetic retinopathy [14,15] and moderate consumers had the lowest risk (OR 0.60, 95% CI 0.37-0.99) for proliferative retinopathy.…”

Comportamentos e comorbidades associados às complicações microvasculares do diabetes

“…(16) Although no statistically significant association was observed between alcohol consumption and microvascular complications of diabetes mellitus, diverging of the findings of a retrospective study that showed association between these variables, (18) it is known that excessive alcohol consumption in the long term increases the incidence of complications of disease while the reduced consumption is considered a protective factor. (19) The frequency of individuals who do not smoke and who had microvascular complications was significantly higher when compared to individuals who smoked. This finding differs from results found in another study in which smokers were nearly 11 times more likely to microvascular complications.…”