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Alcohol Consumption and Diabetes Preventive Practices:Preliminary Findings from the
U.S.-Mexico Border
Patrice A.C. Vaeth, Dr.P.H.
Raul Caetano, M.D., Ph.D.
University of Texas, School of Public Health, Dallas Regional Campus
Alcohol Consumption and Diabetes Preventive Practices
Alcohol consumption, even at low levels, is associated with poor adherence to self-management practices.*
* Ahmed et al. Diabetic Medicine 2006;23:795-802. Chew et al. Family Medicine 2005;37:589-594. Johnson et al. Archives of Family Medicine 2000;9:964-970.
Adjusted OR (95% CI) of Nonadherence to Diabetes Preventive Practices by Drinking Category (2001 BRFSS)
Moderate Drinker Heavy Drinker
(n=2,859) (n=198)
No daily glucose self-monitoring 1.3 (1.1-1.5) 1.8 (1.1-2.9)
No annual HbA1c monitoring 1.1 (0.8-1.4) 1.3 (0.6-2.7)
No professional foot exam 1.1 (0.9-1.3) 1.4 (0.8-2.3)
No annual dilated eye exam 1.2 (1.0-1.4) 2.2 (1.4-3.5)
No formal diabetes education 1.0 (0.9-1.2) 1.3 (0.8-2.0)
No annual provider visit 1.8 (1.4-2.4) 1.7 (0.9-3.2)
Controlling for age, gender, race, education, marital status, income, health care coverage, duration of diabetes, health status, and insulin use.
L.D. Chew et al. Family Medicine 2005;37:589-594
Adherence to Diabetes Self-Care Behaviors by Past Year Average Daily Alcohol Consumption (Kaiser Permanente Data, N=65,996)
Exercise
Diet
Medication
Self-Monitoring
NoHbA1c
Smoking
NS P > .10, † P=.10, * P=.05, ** P=.01, *** P < .001.A. T. Ahmed et al. Diabetic Medicine 2006;23:795-802.
Alcohol, Ethnicity, and Diabetes
How does the association between drinking and diabetes self-care practices vary by ethnicity and culture?
Why is this important? Diabetes is common and disproportionately
affects certain ethnic groups. Drinking is common and drinking practices
differ in relation to ethnicity and culture.
Age-Adjusted Prevalence of Diagnosed Diabetes:
Adult U.S. General Population and by Ethnic Group, 2002-2007
02468
101214161820
U.S.
Non- HispanicWhiteAsian American
Non- HispanicBlackHispanic
%
Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
Age-Adjusted Prevalence of Diagnosed Diabetes:
Adult U.S. General Hispanic Population and by
Hispanic National Group, 2002-2007
02468
101214161820
All Hispanics
Puerto Rican
Mexican American
Cuban American
Central/ SouthAmerican
%
Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
Diabetes in U.S.-Mexico Border Regions
PAHO 2002, U.S.-Mexico Border Diabetes Prevention and Control Project. U.S. side: 15.7%
11.4% aware 4.3% unaware
Mexican side: 15.1% 8.5% aware 6.6% unaware
U.S.-Mexico Border Study
Funded by NIAAA. Multistage cluster sample. Data collected in U.S.-Mexico border areas of
California, Arizona, New Mexico, and Texas between March 2009 and June 2010.
Face-to-face interviews conducted in respondents’ homes in either Spanish or English.
N=1307. Response rate of 67%. Prevalence of self-reported diabetes: 14.2%
Selected Characteristics of those with Diabetes in the
Border Sample (N=184)
DiabeticsNon-Diabetics
Mean age 58 years 41 years Female gender 55% 56% Foreign birth(Mexico) 63% 51% < High school education 54% 36% Annual income < &10,000. 29% 27% No medical insurance 31% 49% Obese 54% 39%
Number of Drinks Consumed per Week and the Proportion who Binged at Least Once
per Year among Men and Women Residing in U.S.-Mexico Border Regions (N=1307).
0
10
20
30
40
% Binge 1+/ year
Men Women
# ofdrinks/
week
Binge DrinkingMen: ≥ 5 drinks within a 2 hour period. Women: ≥ 4 drinks within a 2 hour period.
0
2
4
6
8
10
12
14
# drinks/ week
Men Women
%
The Number of Drinks Consumed Per Week among Non-Diabetic and Diabetic
Male and Female Drinkers (N=1307)
0
5
10
15
20
Men Women
Non- Diabetic Diabetic
# ofDrinks/
weekP =.04
P < .001
Proportion of Abstainers, Non-Binge Drinkers, and Binge* Drinkers
by Diabetic Status (N=1307)
0102030405060708090
Abstain No Binge Binge
Non- Diabetic Diabetic
%
Binge DrinkingMen: ≥ 5 drinks within a 2 hour period. Women: ≥ 4 drinks within a 2 hour period.
NS
0102030405060708090
Abstain No Binge Binge
Non- Diabetic Diabetic
% P < .001
Men Women
Non-adherence to Diabetes Preventive Practices on the U.S.-Mexico Border by
Drinking Status (N=184)
010203040506070
No dr visits**
No HbA1c*
No eye exam*
No dr feet exam*
No self- check***
Abstain
No Binge
Binge
%
* P > .05** P < .05*** P < .001
Adjusted OR (95% CI) of Non-adherence to Diabetes Preventive Practices by
Drinking Category (N=184)Non-Binge Binge
Drinker Drinker
No annual provider visit 0.49 (0.09-2.64) 6.95 (1.01-48.19)
No annual HbA1c monitoring 0.28 (0.03-3.08) 1.49 (0.04-59.62)
No annual dilated eye exam 2.97 (1.22-7.22) 4.07 (0.72-23.11)
No professional foot exam 0.45 (0.12-1.69) 0.23 (0.04-1.39)
No glucose self-monitoring 2.89 (0.78-10.72) 4.57 (1.53-13.65)
Controlling for age, gender, place of birth, education, income, and health care coverage.
Lack of Screening for Diabetes among Non-Diabetics in Relation to
Drinking Status (N=1108)
0
10
20
30
40
50
60
70
Men Women
Abstain Non- Binge Binge
%P < .001 NS
Adjusted OR (95% CI) for No Screening for Diabetes in the Previous Three Years among Non-Diabetics by Drinking Category (N=1108)
Risk Factors:
Drinking Pattern (ref: non-binge drinking)
Abstention 1.59 (1.11-2.29)
Binge drinking 1.50 (1.01-2.26)
Age (ref: 60+ years)
20-49 years 2.79 (1.84-4.23)
No medical insurance 1.34 (1.01-1.80)
Protective Factors:
Female gender 0.90 (0.49-0.90)
Controlling for place of birth, education, and income.
Conclusions
Alcohol consumption appears to influence some, but not all preventive behaviors.
A pattern of heavy alcohol consumption may be indicative of an overall lifestyle that is not conducive to positive health behaviors.
Health providers should routinely assess the drinking patterns of their patients and address its significance as a risk factor for poor self-care practices and poor glucose control.
Acknowledgement
This work was supported by a grant
(R01-5R01AA16827-3) from the
National Institute on Alcohol Abuse and Alcoholism to the University of Texas School of Public Health.