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.