Valmadrid C T et al Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus. JAMA 1999;282:239-46.

Consumption of one to  two alcoholic drinks per day is associated with a statistically significant reduction of risk of death for older Type 2 diabetics.

Time to mortality from coronary heart disease of 983 men and women with  older-onset diabetes mellitus was extracted from a population-based (southern Wisconsin) prospective cohort study known as the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Coronary heart disease mortality  comparison to never drinkers by category of alcohol (beer, wine and spirits combined) intake was determined through Cox proportional hazards regression adjusted for age, sex, cigarette smoking (never, former, current),  glycosylated hemoglobin level, insulin use, plasma C-peptide level, history of angina or myocardial infarction, digoxin use, and the presence and severity of retinopathy. Relative risks were 0.54 (95% confidence  interval 0.33-0.90), 0.44 (0.23-0.84), and 0.21 (0.09-0.48) for those with alcohol intake of less than 2 g/day ("less frequent than 1 drink a week"), ³ 2 to 13 g/day, and 14 or  more g/day ("about 1 drink or more a day") respectively. Analysis for all-cause mortality and alcohol consumption resulted in relative risks of 0.64 (0.48-0.86), 0.47 (0.33-0.69), and 0.49 (0.33-0.74) for intake levels of less than 2, 2 to 13, and 14 or more g/d, respectively.

The authors concluded: "Alcohol use was inversely associated with risk of coronary heart disease mortality in older-onset diabetic  subjects."

Lazarus R et al Alcohol intake and insulin levels. The Normative Aging Study. AM J EPIDEMIOL 1997;145:909-16.

The authors review insulin resistance as a positive  association with coronary heart disease. They hypothesized that moderate alcohol intake would be associated with lower levels of insulin resistance. From 1987 to 1991, fasting insulin levels and insulin resistance indices were measured in a cross-sectional analysis of 938 nondiabetic men who had been recruited out of the original Normative Aging Study begun in Boston in 1961. Alcohol intake, obtained by interview, was categorized into none, low (0.1 or greater but less than 10 g/day), moderate (10 or greater but less than 30 g/day), and high (30 or more g/day). Adjustments in the statistical analyses accounted for the following potential  confounders: age, obesity (body mass index), fat distribution (waist/hip circumference ratio), smoking, dietary energy intake, saturated fat intake, antihypertensive medication, and physical activity.

"Subjects consuming moderate amounts of alcohol had the lowest fasting insulin and fasting insulin resistance index values." For example, compared to moderate drinkers, higher values for fasting insulin  resistance index values were significant at p-values of 0.011 for abstainers, 0.004 for low and 0.04 for high intake subjects. "These findings suggest the possibility that the coronary heart disease-protective  effects of moderate alcohol use are at least partially mediated by insulin." The authors did not separate types of alcohol consumed. They state "one or two drinks a day corresponds approximately to the moderate (10 - 29.9 g/day) category."

Rimm E Prospective study of cigarette smoking, alcohol use, and the risk ofdiabetes in men. BMJ 1995;310:555-9.

Moderate alcohol consumption significantly decreased the risk of diabetes.

Data were analyzed over a six-year period from the United States Health Professionals Follow-up Study. Subjects were 41,810 males aged 40 - 75 years who were free of diabetes, cardiovascular disease and cancer at the initial questionnaire in 1996. Total daily alcohol was calculated and not separated by wine, beer or spirits. A standard glass of wine was estimated to contain 10.8 g  of alcohol.

There was a strong inverse association between alcohol consumption and the risk of non-insulin dependent diabetes mellitus. After controlling for possible confounders of age, body mass index, family history of diabetes, physical activity and smoking, multivariate analysis demonstrated that men who consumed 30.0 to 49.9 g of alcohol daily (about two and a half to four and a half glasses of wine) had a relative risk of 0.61 (95% confidence interval 0.44 to 0.91) compared with abstainers.

The authors concluded that the reduced risk of diabetes may be due to an increased insulin sensitivity associated with moderate alcohol consumption.

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