Alcohol in children with type 1 diabetes?

StudyPopulationInterventionOutcomesResultsCommentsDesignEL
Moriarty et al, 19934549 patients with type 1 diabetes
Mean age 22.2 ± 1.3 (SEM) years
UK
Fasted overnight, followed by ethanol 0.5 g/kg by intravenous bolus 0.25 g/kg/hour
versus
saline
Blood glucose monitoringNo change in: glucose infusion rate needed to maintain euglycaemia, initial rate of fall of blood glucose, lowest blood glucose, rate of blood glucose recoveryUnknown if study was randomised
One-off trial
Small numbers
Crossover controlled studyIIa
Turner et al, 20014536 men
Aged 19–51 years
Dry white wine (0.75 g/kg)
versus
mineral water
  1. Blood glucose
  1. No significant difference in evening or overnight blood glucose levels
    Morning fasting and postprandial blood glucose levels were significantly lower after consumption of wine (postprandial peak 8.9 (1.7) vs. 15 (1.5) mmol/l, p < 0.01)
  2. From 10:00, 5 subjects required treatment for hypoglycaemia after wine, however no subjects experienced hypoglycaemia after mineral water
Unknown if study was randomised
One-off trial
Small numbers
Crossover controlled studyIIa
Koivisto et al, 199345510 male patients with type 1 diabetes
Mean age 34 ± 3 years
Finland
Ethanol 1 g/kg (vodka, red wine and cognac)
versus
water
  1. Diurnal glucose profile
  1. No effect of alcohol on blood glucose injections until 10:00
  2. None of the patients had hypoglycaemia (< 3 mM) during the study
Unknown if study was randomised
One-off trial
Small numbers
Crossover controlled studyIIa
Frische et al, 19954579 adult patients with type 1 diabetes
Mean age 36.4 ± 6.1 years
Germany
Alcohol 0.7 g/kg at 22:00
versus
no alcohol
Perceived blood glucose (accuracy index %)25 ± 13% vs. 28 ± 13% (NS)Unknown if study was randomised
One-off trial
Small numbers
Crossover controlled studyIIa
Kerr, 19904587 adult men with type 1 diabetes
Age range 19–37 years
Nottingham, UK
Ethanol 0.75g/kg with fruit squash
versus
fruit squash only
During hypoglycaemia heart rate, finger tremor and sweat production
Hypoglycaemia awareness
During hypoglycaemia heart rate was higher after alcohol. 86.1 ± 5.5 vs. 81.0 ± 5.5 (p < 0.01)
During hypoglycaemia finger tremor was less marked after ethanol (p < 0.05)
During hypoglycaemia sweat production was increased after ethanol (p < 0.05)
At blood glucose of 4.5 mmol/l, drinking ethanol was associated with an increase in symptom score (p < 0.01) predominately due to increased sweating, palpitation, facial flushing and blurred vision which was sustained during hypoglycaemia. Symptom score did not change significantly in the placebo group
Baseline reaction times were similar but slowing during hypoglycaemia was more marked after ethanol (p < 0.05)
Unknown if study was randomised
One-off trial
Small numbers
Crossover controlled studyIIa
Moss et al, 1992459891 patients with diabetes diagnosed before the age of 30 years and taking insulin
Aged 2–78 years
Baseline and 4-year follow-up examinationDiabetic retinopathy as defined from stereographic fundus photographyAverage (for the previous year) alcohol consumption, as determined by questionnaire, was inversely associated with prevalence of proliferative diabetic retinopathy; OR 0.49, 95% CI 0.27 to 0.92
Proliferative diabetic retinopathy decreased from 43.1% in abstainers to 25.7% in heavy drinkers
For recent consumption (average of the week before the follow-up examination), proliferative diabetic retinopathy decreased from 38.2% in abstainers to 23.3% in moderate drinkers whereafter it increased to 28.6% in heavy drinkers. However the OR was not significant (OR 0.63, 95% CI 0.37 to 1.09)
The analysis of drinking history shows ex-drinkers have the highest prevalence of proliferative diabetic retinopathy (43.8%). However, it was not significantly different from non-drinkers (40.7%) (ex-drinkers OR 1.47, 95% CI 0.46 to 4.70, current drinkers OR 1.01, 95% CI 0.35 to 2.89)
Cohort follow-upIIb
Cox et al, 1996460154 male patients with type 1 diabetes
Mean age 63.5 years (SD 8.1)
USA
Survey of alcohol habits and metabolic controlRelationship between alcohol and compliance with insulin regimen
HbA1c
F(3,86) = 4.28, p < 0.01
(no raw numbers given)
No relationship
SurveyIII

From: Evidence tables

Cover of Type 1 Diabetes
Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People.
NICE Clinical Guidelines, No. 15.2.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2004 Sep.
Copyright © 2004, National Collaborating Centre for Women’s and Children’s Health.

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