Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours

Abstract

Aims: Our aim was to examine the associations of alcohol consumption with six diabetes self-care behaviours.

Methods: We determined levels of alcohol consumption and examined associations between alcohol consumption and six self-care behaviours in 65 996 adults with diabetes who received care through Kaiser Permanente Northern California and who responded to a 1994-1997 survey. Adherence with recommendations for self monitoring of blood glucose, HbA1c testing, and diabetes medications were determined from electronic records; smoking and use of diet and exercise to treat diabetes were self reported. Multiple logistic regression models were used to determine the associations between alcohol consumption (average number of drinks/day in the past year) and the probability of adherence to each self-care behaviour.

Results: Current alcohol consumption was reported by 50.8% of adults with diabetes. In adjusted models, we observed a gradient of increasing risk for poor adherence to diabetes self-care behaviours with increasing alcohol consumption, starting with those who consume even one drink a day. Former drinkers had the greatest compliance with each self-care behaviour, except for current smoking.

Conclusions: Alcohol consumption is a marker for poorer adherence to diabetes self-care behaviours. These findings highlight the importance of routine assessment of alcohol intake in people with diabetes, particularly as half of adults with diabetes consume alcohol. Given extant evidence that moderate alcohol intake may have cardiovascular benefits for patients with diabetes, examination of the trade-offs between cardiovascular benefits vs. potential risk of lower adherence with self-care behaviours deserves study.

Figure 1

Predicted probability of adherence to each of six diabetes self-care behaviours, by average daily consumption of alcohol-containing drinks in the past year: (a) Use of exercise to treat diabetes; (b) use of diet to treat diabetes; (c) non-adherence to oral glucose-lowering medications; (d) adherence to self monitoring of blood glucose recommendations; (e) no HbA_1c testing; (f) current smoking. Model 1 (white bar) is adjusted only for age and sex, model 5 (black bar) is adjusted for age, sex, ethnicity, education, per cent working class in census block group, obesity, duration of diabetes, use of insulin, use of oral glucose lowering medications, prior chronic renal failure, and prior hospital admission for cardiovascular disease. P-values: NS, P > 0.10, †P = 0.10, *P = 0.05, **P = 0.01, ***P < 0.001 for comparison with lifetime abstainers.