Patrice A.C. Vaeth, Dr.P.H. Raul Caetano, M.D., Ph.D.

1. 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

2. Alcohol Consumption and Diabetes Preventive 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. • Alcohol consumption, even at low levels, is associated with poor adherence to self-management practices.*

3. 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

4. Adherence to Diabetes Self-Care Behaviors by Past Year Average Daily Alcohol Consumption (Kaiser Permanente Data, N=65,996) Exercise Self- Monitoring No HbA1c Diet Medication Smoking NS P > .10, † P=.10, * P=.05, ** P=.01, *** P < .001. A. T. Ahmed et al. Diabetic Medicine 2006;23:795-802.

5. 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.

6. Age-Adjusted Prevalence of Diagnosed Diabetes: Adult U.S. General Population and by Ethnic Group, 2002-2007 % 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.

7. Age-Adjusted Prevalence of Diagnosed Diabetes: Adult U.S. General Hispanic Population and by Hispanic National Group, 2002-2007 % 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.

8. 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

9. 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%

10. 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%

11. 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). # of drinks/ week % Binge Drinking Men: ≥ 5 drinks within a 2 hour period. Women: ≥ 4 drinks within a 2 hour period.

12. The Number of Drinks Consumed Per Week among Non-Diabetic and Diabetic Male and Female Drinkers (N=1307) # of Drinks/ week P =.04 P < .001

13. Proportion of Abstainers, Non-Binge Drinkers, and Binge* Drinkers by Diabetic Status (N=1307) Men Women % NS % P < .001 Binge Drinking Men: ≥ 5 drinks within a 2 hour period. Women: ≥ 4 drinks within a 2 hour period.

14. Non-adherence to Diabetes Preventive Practices on the U.S.-Mexico Border by Drinking Status (N=184) % * P > .05 ** P < .05 *** P < .001

15. Adjusted OR (95% CI) of Non-adherence to Diabetes Preventive Practices by Drinking Category (N=184) Non-Binge Binge DrinkerDrinker 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.

16. Lack of Screening for Diabetes among Non-Diabetics in Relation to Drinking Status (N=1108) % NS P < .001

17. 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.

18. 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.

19. 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.