Alcohol consumption and the incidence of type II diabetes

1. Alcohol consumption and the incidence of type II diabetes 中山醫學大學 公衛系 黃駿煌

2. 生理機轉 • 過度飲酒會造成低血糖 • 因氧化還原狀態的改變（NADH對 NAD+的比例增高），抑制糖新生成作用而引起 • 酒精造成下視丘──腦下腺──腎上腺功能下降 • 糖尿病患者比沒有糖尿病者，易有血小板凝集、高密度膽固醇不足和較高冠狀動脈疾病的發生率而酒可以改善胰島素的抗性、增加高密度膽固醇的濃度、防止血小板的凝集和促進纖維蛋白分解 • 持續大量喝酒會造成葡萄糖的耐度受損，主要在於抑制胰島素的分泌及增加胰島素的抗性

3. Introduction • Type 2 diabetes is a common disease in industrialized countries • Diabetes mellitus is the fourth leading cause of death in Taiwan (民92) • In 1998, the treatment of diabetes mellitus consumed 25% of all spending under the Medicare program in the U.S.

4. Introduction(cont) • light drinking to moderate drinking 1.protect DM 2.increase insulin sensitivity • Insulinresistance and hyperinsulinaemia play an important part in the aetiology of type II diabetes • Some studies report that heavy drinking is a risk factor for diabetes

5. The British Regional Heart Study Cohort study: • January 1978–July 1980 ~ December1995 (mean period:16.8 years) • Subjects :5221 men (有效收案:99%) • age:40–59 • Location:England,Wales, and Scotland(24 towns) • Outcome:the relation between alcohol and type II diabetes and the possible mediating effects of HDL-cholesterol and serum insulin

6. Methods-alcohol intake • Divided into five groups→weekly intake 1.Non-drinkers (n=289) 2.Occasional (<1 unit/week) (n=1212) 3.Light (1–15 units/week). (n=1711) 4.Moderate (15–42 units/week). (n=1425) 5.Heavy (>42 units/week). (n=584) • occasional drinkers are used as the baseline group

7. Methods-biological measurement • BMI: Obesity:BMI ≥28.0 • Blood lipids: state:non-fasting obtained time:between 0830 and 1830 • Blood glucose: glucose oxidase method • Serum insulin: ELISA→two site adjusted log insulin=(unadjusted log insulin-mean log insulin for the hour of sampling)+ the grand mean log insulin level

8. Pre-existing undiagnosed coronary heart disease: defined as those with no recall of a doctor diagnosis of CHD • DM:practitioners→biennial review

9. Methods-Statistical methods • Cox proportional hazards model • The Cox proportional hazards model was used to assess the effects of alcohol intake on the risk of type II diabetes incidence • Variables 在進入Cox’s model時,是用平方關係進入的 • Logistic regression • Logistic regression was used to assess the odds of having increased levels of serum insulin and HDL-cholesterol

10. Results-event rate • 198 new case(2.6/1000 person years) • moderate drinkers: the lowest rates • Heavy drinkers: the highest rates

11. Results-relative risk

12. Results-trend for HDL-C and insulin

13. Results- Alcohol intake and metabolic risk factors

14. Results- Alcohol intake, metabolic factors, and risk of type II diabetes

15. Results- Alcohol intake, high risk subjects, and diabetes

16. Discussion • Risk decreased progressively up to levels of moderate drinking and increased in heavy drinkers • SerumHDL-cholesterol and serum insulin accounted for only a small proportion of the reduced risk seen in moderate drinkers • Heavy drinkers have higher risk than light / moderate drinkers and in many studies heavy drinkers have the highest risk Ex:the Paris Prospective Study

17. Conclusion • A non-linear relation was seen between alcohol intake and the incidence of type II diabetes • HDL-cholesterol and serum insulin seemed to explain only some of the reduction in risk of type II diabetes associated with moderate drinking • The relations between alcohol consumption, obesity, insulin concentrations, and blood lipids need to be explored

18. Thanks for your listening