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CORK Bibliography: Dental Issues

103 citations. January 2004 to present

Prepared: March 2008

Agardh EE; Carlsson S; Ahlbom A; Efendic S; Grill V; Hammar N et al. Coffee consumption, type 2 diabetes and impaired glucose tolerance in Swedish men and women. Journal of Internal Medicine 255(6): 645-652, 2004. (27 refs.)

Objectives. The association between coffee consumption, type 2 diabetes and impaired glucose tolerance was examined. In addition, indicators of insulin sensitivity and beta-cell function according to homeostasis model assessment were studied in relation to coffee consumption. Design. Population-based cross-sectional study. Setting and subjects. The study comprised 7949 healthy Swedish subjects aged 35-56 years residing within five municipalities of Stockholm. An oral glucose tolerance test identified 55 men and 52 women with previously undiagnosed type 2 diabetes and 172 men and 167 women with impaired glucose tolerance. Information about coffee consumption and other factors was obtained by questionnaire. Results. The relative risks (adjusted for potential confounders) of type 2 diabetes and impaired glucose tolerance when drinking greater than or equal to5 cups of coffee per day compared with less than or equal to2 cups per day in men were 0.45 [95% confidence intervals (CI) 0.22-0.92] and 0.63 (CI: 0.41-0.97), respectively, and in women 0.27 (CI: 0.11-0.66) and 0.47 (CI: 0.29-0.76) respectively. In subjects with type 2 diabetes and impaired glucose tolerance, high coffee consumption (greater than or equal to5 cups day(-1)) was inversely associated with insulin resistance. In addition, in those with type 2 diabetes and in women (not in men) with impaired glucose tolerance high coffee consumption was inversely associated with low beta-cell function. In women, but not obviously in men, with normal glucose tolerance, coffee consumption was associated with a reduced risk of insulin resistance. Conclusions. The results of this study indicated that high consumers of coffee have a reduced risk of type 2 diabetes and impaired glucose tolerance. The beneficial effects may involve both improved insulin sensitivity and enhanced insulin response.

Beulens JWJ; Stolk RP; Van der Schouw YT; Grobbee DE; Hendriks HFJ; Bots ML. Alcohol consumption and risk of type 2 diabetes among older women. Diabetes Care 28(12): 2933-2938, 2005. (24 refs.)

OBJECTIVE - This study aimed to investigate the relation between alcohol consumption and type 2 diabetes among older women. RESEARCH DESIGN AND METHODS- Between 1993 and 1997, 16,330 women aged 49-70 years and free from diabetes were enrolled in one of the Dutch Prospect-EPIC ( European Prospective Study Into Cancer and Nutrition) cohorts and followed for 6.2 years (range 0.1-10.1). At enrollment, women filled in questionnaires and blood samples were collected. RESULTS - During follow-up, 760 cases of type 2 diabetes were documented. A linear inverse association (P = 0.007) between alcohol consumption and type 2 diabetes risk was observed, adjusting for potential confounders. Compared with abstainers, the hazard ratio for type 2 diabetes was 0.86 (95% CI 0.66-1.12) for women consuming 5-30 g alcohol per week, 0.66 (0.48-0.91) for 30-70 g per week, 0.91 (0.67-1.24) for 70-140 g per week, 0.64 (0.44-0.93) for 140-210 g per week, and 0.69 (0.47-1.02) for > 210 g alcohol per week. Beverage type did not influence this association. Lifetime alcohol consumption was associated with type 2 diabetes in a U-shaped Fashion. CONCLUSIONS - our findings support the evidence of a decreased risk of type 2 diabetes with moderate alcohol consumption and expand this to a population of older women.

Bidel S; Hu G; Sundvall J; Kaprio J; Tuomilehto J. Effects of coffee consumption on glucose tolerance, serum glucose and insulin levels: A cross-sectional analysis. Hormone and Metabolic Research 38(1): 38-43, 2006. (50 refs.)

Objective: Coffee has several metabolic effects that could reduce the risk of type 2 diabetes. Our objective was to examine the effects of coffee consumption on glucose tolerance, glucose and insulin levels. Research design and methods: A subsample of subjects aged 45 to 64 years in 1987 and in 1992 from the population-based FINRISK study (12 287 individuals) was invited to receive the standard oral glucose tolerance test at baseline. Plasma samples were taken after an overnight fast, and a two-hour oral glucose tolerance test was administered. Fasting and two-hour plasma glucose and insulin were measured in 2434 subjects with data on coffee use and potential confounders. Results: After adjustment for potential confounding factors (age, body mass index, systolic blood pressure, occupational, commuting and leisure time physical activity, alcohol and tea drinking, smoking), coffee consumption was significantly and inversely associated with fasting glucose, two-hour plasma glucose, and fasting insulin in both men and women. Coffee consumption was significantly and inversely associated with impaired fasting glucose, impaired glucose regulation, and hyperinsulinemia among both men and women and with isolated impaired glucose tolerance among women. Conclusions: In this cross-sectional analysis, coffee showed positive effects on several glycemia markers.

Bonelli L; Aste H; Bovo P; Cavallini G; Felder M; Gusmaroli R et al. Exocrine pancreatic cancer, cigarette smoking, and diabetes mellitus: A case-control study in Northern Italy. Pancreas 27(2): 143-149, 2003. (34 refs.)

The role of cigarette smoking and diabetes mellitus as risk factors for exocrine pancreatic cancer (PC) was investigated in a hospital based case-control study. Current smokers were at increased risk for PC (OR = 2.36, 95% CI 1.53 - 3.63): the magnitude of the risk was related to the lifetime amount of smoking (chi(trend)(2) = 17.00; P < 0.0001). Among former smokers, after 15 years from ceasing smoking, the risk for PC dropped to the level of a lifetime nonsmoker, whichever the lifetime smoking amount. Diabetes was associated with a 2.89-fold increased risk for PC (95% CI 1.71 - 4.86): the risk was 4.76 (95% CI 1.99 - 11.53) for diabetes diagnosed up to 2 years before the diagnosis of PC and dropped to 2.07 (95% CI 1.02 - 4.20) for diabetes diagnosed more than 5 years before PC. The risk for PC was estimated according to the treatment used to control diabetes: it was 6.49 (95% CI 2.28 - 18.48) for insulin treated diabetes and 2.12 (95% CI 1.16 - 3.87) for diabetes treated with oral hypoglycemic drugs. The risk of PC for diabetes treated for more than 5 years before the diagnosis of PC was 6.21 (95% CI 1.61 - 23.96) for patients treated with insulin and 1.21 (95% CI 0.50 - 2.92) for those treated with oral hypoglycemic drugs: the type of treatment needed to control the disease may discriminate between the diabetes that represents a consequence of cancer from the diabetes that could represent an etiological cofactor. More studies are needed to clarify whether long-lasting insulin-treated diabetes is an etiological co-factor in PC.

Carlsson S; Midthjell K; Grill V. Smoking is associated with an increased risk of type 2 diabetes but a decreased risk of autoimmune diabetes in adults: An 11-year follow-up of incidence of diabetes in the Nord-Trondelag study. Diabetologia 47(11): 1953-1956, 2004. (9 refs.)

Aims/hypothesis. We compared the association between smoking habits and later occurrence of type 2 diabetes on the one hand and between smoking and diabetes with autoimmunity on the other hand. Methods. We used data from a prospective study of 11-year cumulative incidence of diabetes in the Nord-Trondelag Health Survey. Results. Confirming previous reports, heavy smoking (greater than or equal to20 cigarettes per day) carried an increased relative risk (RR) of type 2 diabetes (n=738, RR=1.64, 95% Cl: 1.12-2.39). In contrast, smoking reduced the risk of latent autoimmune diabetes in adults (LADA) and of traditional type 1 diabetes (LADA n=81, RR=0.25, 95% CI: 0.11-0.60; type 1 diabetes, n=18, RR=0.17, 95% Cl: 0.04-0.73). Conclusions/interpretations. The results indicate that nicotine influences autoimmune processes in human diabetes.

de Luis DA; Fernandez N; Aller R; de Luis J; Arranz M; Izaola O. Relation between total homocysteine levels and beer intake in patients with diabetes mellitus type 2. Annals of Nutrition and Metabolism 47(3-4): 119-123, 2003. (24 refs.)

Background/Aim: The evaluation of the significance of hyperhomocysteinemia in type 2 diabetes is further complicated by the multiple ways of considering impaired renal function, vitamin status, and lifestyle. The aim of our study was to investigate the relation between macro- and micronutrient intakes and homocysteine levels in a population having diabetes type 2. Methods: A total of 155 patients with diabetes mellitus type 2 attending our Diabetes Service (90 females and 65 males) were enrolled in a consecutive way. All patients underwent determination of fasting blood homocysteine, glycated hemoglobin, glucose, vitamin B-12, and folate levels. Microalbuminuria was evaluated on the basis of a 24-hour urine. The patients were instructed to keep 3-day written food records incorporating the use of food scales and models to enhance portion size accuracy. Alcohol drinking, physical activity, and smoking habits were also registered. Results: The mean homocysteine levels were 10.5 +/- 4.3 mumol/l. The mean glucose and Hb A(lc) levels were 9.5 +/- 3 mmol/l and 7.8 +/- 1.4%, respectively. The vitamin status was normal: 592.6 +/- 522 pg/ml vitamin B-12 and 10.5 +/- 5.5 ng/ml folic acid. Mean microalbuminuria was 81.7 +/- 238 mg/day. The calorie intakes were normal (carbohydrates 43%, proteins 23.8%, and lipids 33.1%). A decrease in daily intakes of vitamins (A, B-1, D, and E) and trace elements (Zn, Mg, Se, and Ca) was detected. High daily intakes were detected for protein, P, and vitamins C, B-12, K and P 29.7% of the patients drank beer and 18% other alcoholic beverages. 11.7% of the patients smoked, and 77.7% maintained daily physical activity (mean/day 25.7 +/- 20.9 min). Only protein (g/day; r = 0.5; 0 < 0.005) and beer (ml/day; r = -0.46; p < 0.05) correlated with the total homocysteine levels. The daily intakes of vitamin B-12 and folic acid were inversely correlated with the total homocysteine levels: r = -0.29; p < 0.05 and (r = -0.12; p < 0.05), respectively. Physical activity and smoking habits were not correlated. In the multivariate analysis with a dependent variable (total homocysteine) adjusted for age, sex, microalbuminuria, and, nutrient intakes (proteins, folic acid, and vitamin B-12) arid beer remained in the model. Conclusion: The present study-shows that protein intake and beer could modify the levels of total homocysteine in patients with diabetes type 2.

Dillie KS; Mundt M; French MT; Fleming MF. Cost-benefit analysis of a new alcohol biomarker, carbohydrate deficient transferrin, in a chronic illness primary care sample. Alcoholism: Clinical and Experimental Research 29(11): 2008-2014, 2005. (38 refs.)

Background: Carbohydrate Deficient Transferrin (CDT) is a new alcohol biomarker recently approved by the Food and Drug Administration for alcohol screening. Limited information is available on the economic benefits of alcohol biomarkers. Our objective was to conduct a cost-benefit analysis (CBA) of the CDT test in a primary care sample of patients being treated for diabetes and hypertension. Methods: A decision tree was created using data from national surveys, published literature, and two brief intervention trials conducted in primary care settings. The decision tree was used to estimate the costs and benefits of CDT under different scenarios. Results: For the base case, utilizing CDT in addition to patient self-report resulted in an increase from 28 to 53 problem drinking cases identified out of 70 cases screened. With increased detection and subsequent intervention, the average medical and legal costs were far lower in the CDT arm of the study. When these avoided costs were incorporated into the model, an overall savings of $212.30 per patient was realized with CDT testing. Monte Carlo analysis also indicated a trend toward cost savings, with a mean cost savings of approximately $353 and a range of $1,619 in savings to $450 in costs for 1,000 simulations of the decision tree model. Conclusion: This CBA suggests that the addition of routine CDT screening to patient self-report may provide positive net economic benefits in primary care settings.

Durlach V; Da Rocha G; Kleinebreil L; Attali JR. Diabetes and tobacco smoking: The DiabCare France experience. (meeting abstract). Diabetologia 46(Supplement 2): A236-A236, 2003. (0 refs.)

Eliasson M; Asplund K; Nasic S; Rodu B. Influence of smoking and snus on the prevalence and incidence of type 2 diabetes amongst men: The northern Sweden MONICA study. Journal of Internal Medicine 256(2): 101-110, 2004. (27 refs.)

Objective: To explore the effect of smoking and smokeless tobacco, 'snus', on the risk of type 2 diabetes. Design. Population-based cross-sectional and prospective follow-up study in northern Sweden. Subjects. A total of 3384 men, aged 25-74 years, who participated in the MONICA study in 1986, 1990, 1994 or 1999, 1170 of whom had an oral glucose tolerance test. In 1999, 1757 men from previous cohorts returned for re-examination. Main outcome measures. We compared the prevalence of type 2 diabetes or pathological glucose tolerance (PGT) amongst tobacco users to that of nonusers at entry into the study and at follow-up, using odds ratios. Results. Compared with never users, the age-adjusted risk of prevalent clinically diagnosed diabetes for ever smokers was 1.88 (CI 1.17-3.0) and for smokers 1.74 (0.94-3.2). Corresponding odds ratios for snus users were 1.34 (0.65-2.7) and 1.18 (0.48-2.9). We found no increased risk of prevalent PGT in snus users or smokers. Former smokers and snus users had an insignificantly increased risk for PGT. Compared with nonusers, the age-adjusted risk of developing clinically diagnosed diabetes during follow-up was 4.63 (1.37-16) in consistent exclusive smokers, 3.20 (1.16-8.8) in ex-smokers and no cases in consistent snus users. The risk of PGT during follow-up was not increased in consistent tobacco users but evident, although not statistically significant, in those who quit snus during the follow-up period, 1.85 (0.60-5.7). Adjustment for physical activity and alcohol consumption did not change the major findings. Conclusions. The risk of diabetes for snus users was not significantly increased. Smoking was associated with prevalent and incident cases of diabetes. Ex-tobacco users tended towards more PGT.

Fleming M; Brown R; Brown D. The efficacy of a brief alcohol intervention combined with %CDT feedback in patients being treated for type 2 diabetes and/or hypertension. Journal of Studies on Alcohol 65(5): 631-637, 2004. (42 refs.)

Objective: Alcohol biomarkers are being developed to improve a physician's ability to identify and intervene with patients with chronic medical problems adversely affected by heavy alcohol use. This article reports the findings of a brief intervention trial which included feedback to patients of their carbohydrate-deficient transferrin (CDT) test results. Method: A pilot study was conducted to test the efficacy of brief clinician advice to reduce alcohol use and improve health status in a sample of 151 patients being treated for Type 2 diabetes and hypertension. The intervention included informing patients of their CDT levels. The patients were randomized to a usual care or brief intervention group. Results: There were no significant differences at baseline between the two groups in alcohol use, CDT levels, addiction rates, age, gender, socioeconomic status or health status measures. Following brief intervention, significant differences were observed in the intervention group in alcohol use and CDT: The proportion of heavy drinkers at the 12-month follow-up compared with baseline decreased from 35.8% to 24.7% in the intervention group, with no change in the control group (p <.044). CDT levels decreased as well from 2.79% to 2.41% (16% change) in the control group and 3.05% to 2.35% (28% change) in the intervention group, with significantly more intervention-group patients reducing their CDT level by at least 25% (p <.006). Conclusions: The study provides new information suggesting brief intervention, combined with feedback on CDT levels, can reduce alcohol use and %CDT in a sample of primary care patients being treated for Type 2 diabetes and hypertension.

Fleming M; Mundt M. Carbohydrate-deficient transferrin: Validity of a new alcohol biomarker in a sample of patients with diabetes and hypertension. Journal of the American Board of Family Practice 17(4): 247-255, 2004. (44 refs.)

Objective: To test the reliability and validity of a new alcohol biomarker. Design: Cross-sectional with matched control. Alcohol use, symptoms of alcohol dependence, health status, current medications, carbohydrate-deficient transferrin (CDT) levels, and gamma-glutamyl transferase levels were assessed. Validity of the %CDT test was estimated using a drinking cutoff of 90 or more drinks in the previous 30 days. Participants: Sample (n = 799) included 89 patients with type 2 diabetes, 299 patients with hypertension, 209 patients with hypertension and type 2 diabetes, and 202 matched control subjects with neither diabetes nor hypertension. Results: Three hundred ninety-six women and 403 men ages 30 to 60 participated in the study. Six percent (45 of 799) reported drinking more than 14 drinks per week, 2% (n = 17) met criteria for alcohol abuse, and 3% (n = 23) met DSM-IV criteria for dependence. The overall sensitivity of the %CDT test was 61% with a specificity of 85%. A receiver operating characteristic curve was used to determine that the best fit was for persons who reported >90 drinks per month and a CDT level >2.5% with an area under the curve of 0.83. Test-retest reliability (R) was 0.94. Conclusions: %CDT levels are useful in detecting and/or confirming high-risk drinking in patients being treated for type 2 diabetes and hypertension.

Ford ES; Mokdad AH; Gregg EW. Trends in cigarette smoking among US adults with diabetes: Findings from the Behavioral Risk Factor Surveillance System. Preventive Medicine 39(6): 1238-1242, 2004. (22 refs.)

Background. Smoking substantially increases morbidity and mortality rates in people with diabetes. Previous studies have shown that the prevalence of smoking among people with diabetes is similar to that among people without diabetes. We sought to examine temporal trends in the prevalence of smoking among people with diabetes since 1990. Methods. We analyzed data from the Behavioral Risk Factor Surveillance System for 1990-2001. Results. The age-adjusted prevalence of smoking among adults with diabetes was 23.6% (men, 25.4%; women, 22.2%) in 1990 and 23.2% (men, 24.8%; women, 21.9%) in 2001. In comparison, the prevalence among participants without diabetes was 24.2% (men, 25.7%; women, 22.8%) in 1990 and 23.2% (men, 24.8%; women, 21.5%) in 2001. Thus, the prevalence of cigarette smoking was similar and remained stable from 1990 through 2001. Among participants with diabetes, significant decreases in the prevalence of smoking occurred among African Americans and those aged �65 years. Conclusions. New efforts and commitments to promote smoking cessation among people with diabetes are needed.

Geslain-Biquez C; Vol S; Tichet J; Caradec A; D'Hour A; Balkau B. The metabolic syndrome in smokers. The DESIR study. Diabetes & Metabolism 29(3): 226-234, 2003. (41 refs.)

Objectives: To test the hypothesis that smokers have a higher frequency of the metabolic syndrome, and a syndrome with different characteristics than non-smokers. Material and methods: The 2,569 men and 2,637 women included in the D.E.S.I.R. study, aged 30-64 years, volunteers from ten French Social Security Health Examination Centres, were studied. The World Health Organization definition of the metabolic syndrome was adapted for this analysis, and insulin resistance was defined by a concentration above the 75(th) centile of the sex-specific distribution of fasting insulin. Results: 28.1% of men and 15.1% of women were current smokers. The metabolic syndrome was twice as frequent in men than in women (22.8% vs 11.0%). Smokers and never-smokers were compared in age stratified samples. In men, the frequencies of hyperglycaemia or hypoglycaemic treatment, dyslipidaemia, microalbuminuria, and central obesity were significantly higher in smokers and 22.5% of smokers and 15.3% of non-smokers had this syndrome (p = 0.001). In women, only dyslipidaemia was more frequent in smokers; in contrast smokers had lower insulin concentrations and hence a lower frequency of hyperinsulinemia. The frequency of the syndrome did not differ between women who smoked and those who did not (6.3% vs 6.0%). Conclusions: In men, the metabolic syndrome was more frequent in smokers than in non-smokers; in contrast, there was no difference for women. For both sexes, syndrome abnormalities tended to be more frequent in smokers than in non-smokers.

Gill GV; Morgan C; MacFarlane IA. Awareness and use of smoking cessation treatments among diabetic patients. Diabetic Medicine 22(5): 658-660, 2005. (9 refs.)

Aims: To investigate awareness of pharmacotherapeutic aids to smoking cessation in diabetic cigarette smokers. Methods: A structured questionnaire-based interview was held by a research nurse individually with consecutively attending cigarette smokers. Results: Of 597 diabetic patients attending a routine clinic, 100 (17%) were current cigarette smokers. Mean (+/- sd) age was 58 +/- 11 years, 58% were male, and 96% Type 2 diabetic patients. Mean daily cigarette consumption was 16/day, for a mean duration of 35 years. There were 34% who had never heard of nicotine replacement therapy (NRT), and of those who had, only 49% considered it safe with diabetes. Bupropion (Zyban) was unknown to 46%, and of those who knew of it, 39% thought it unsafe in diabetic patients. Only 31% of the group had been previously offered NRT, and 14% bupropion. The NHS Quitline was known of by 84%, but only 8% had used it. Conclusions: Cigarette smokers with diabetes have poor uptake, awareness and knowledge of NRT and bupropion as aids to smoking cessation. They comprise a high-risk group, for large and small vessel disease, and these findings are therefore of concern. More active education and support for these patients by medical and nursing staff is needed.

Greenberg JA; Boozer CN; Geliebter A. Coffee, diabetes, and weight control. (review). American Journal of Clinical Nutrition 84(4): 682-693, 2006. (134 refs.)

Several prospective epidemiologic studies over the past 4 y concluded that ingestion of caffeinated and decaffeinated coffee can reduce the risk of diabetes. This finding is at odds with the results of trials in humans showing that glucose tolerance is reduced shortly after ingestion of caffeine or caffeinated coffee and suggesting that coffee consumption could increase the risk of diabetes. This review discusses epidemiologic and laboratory studies of the effects of coffee and its constituents, with a focus on diabetes risk. Weight loss may be an explanatory factor, because one prospective epidemiologic study found that consumption of coffee was followed by lower diabetes risk but only in participants who had lost weight. A second such study found that both caffeine and coffee intakes were modestly and inversely associated with weight gain. It is possible that caffeine and other constituents of coffee, such as chlorogenic acid and quinides, are involved in causing weight loss. Caffeine and caffeinated coffee have been shown to acutely increase blood pressure and thereby to pose a health threat to persons with cardiovascular disease risk. One short-term study found that ground decaffeinated coffee did not increase blood pressure. Decaffeinated coffee, therefore, may be the type of coffee that can safely help persons decrease diabetes risk. However, the ability of decaffeinated coffee to achieve these effects is based on a limited number of studies, and the underlying biological mechanisms have yet to be elucidated.

Hiltunen LA. Are there associations between coffee consumption and glucose tolerance in elderly subjects? European Journal of Clinical Nutrition 60(10): 1222-1225, 2006. (10 refs.)

Objective: To describe the associations between coffee consumption and glucose tolerance among elderly subjects. Design: A survey among an unselected non-institutionalized elderly population. Diabetes was assessed on the basis of self-reports and 2-h oral glucose tolerance test for the subjects on diet treatment or with normal glucose tolerance (NGT). Coffee consumption was assessed by a questionnaire. Setting: Three municipalities in Northern Finland Subjects: All non-institutionalized subjects with baseline normal glucose tolerance or impaired glucose tolerance (IGT) aged 70 years or over. Main outcome measures: Incidence, persistence or impairment of abnormal glucose tolerance (AGT). Results: Forty-two percent of those with NGT and 0-5 cups of coffee daily developed AGT, whereas the corresponding figure was 25% for those who drank more than five cups coffee daily. Fifty-five percent of the subjects with IGT or NGT who drank 0-5 cups coffee daily either persisted in IGT or developed AGT. The corresponding figure was 30% for those drinking more than five cups coffee daily. After adjustment for age, body mass index, cardiovascular disease, smoking, alcohol consumption and physical exercise, among those with NGT, the odds ratio (OR) for developing AGT was 2.3 for those drinking 0-5 cups compared to those drinking more than five cups of coffee daily (95% confidence interval (CI) 0.7-7.2). Correspondingly, low coffee consumption was the most powerful predictor associated with the persistence of IGT or the development of AGT (OR 2.9; 95% CI 1.2-6.9). Conclusions: Low coffee consumption predicts impairment of AGT or persistence of IGT among elderly subjects.

Howard AA; Arnsten JH; Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: A systematic review. (review). Annals of Internal Medicine 140(3): 211-219, 2004. (53 refs.)

Background: Both diabetes mellitus and alcohol consumption are prevalent in the United States, yet physicians are poorly informed about how alcohol use affects risk for or management of diabetes. Purpose: To conduct a systematic review assessing the effect of alcohol use on the incidence, management, and complications of diabetes mellitus in adults. Data Sources: English-language studies in persons 19 years of age or older that were identified by searching the MEDLINE database from 1966 to the third week of August 2003 and the reference lists of key articles. Study Selection: Two independent assessors reviewed 974 retrieved citations to identify all experimental, cohort, or case-control studies that assessed the effect of alcohol use on diabetes risk, control, self-management, adverse drug events, or complications. Data Extraction: Two independent reviewers extracted data and evaluated study quality on the basis of established criteria. Data Synthesis: Thirty-two studies that met inclusion criteria were reviewed. Compared with no alcohol use, moderate consumption (one to 3 drinks/d) is associated with a 33% to 56% lower incidence of diabetes and a 34% to 55% lower incidence of diabetes-related coronary heart disease. Compared with moderate consumption, heavy consumption (>3 drinks/d) may be associated with up to a 43% increased incidence of diabetes. Moderate alcohol consumption does not acutely impair glycemic control in persons with diabetes. Conclusions: Moderate alcohol consumption is associated with a decreased incidence of diabetes mellitus and a decreased incidence of heart disease in persons with diabetes. Further studies are needed to assess the long-term effects of alcohol consumption on glycemic control and noncardiac complications in persons with diabetes.

Howard AA; Klein RS; Schoenbaum EE. Association of hepatitis C infection and antiretroviral use with diabetes mellitus in drug users. Clinical Infectious Diseases 36(10): 1318-1323, 2003. (27 refs.)

We performed a cross-sectional analysis of factors associated with diabetes mellitus among 557 drug users who were recruited from a methadone treatment program and were participating in a longitudinal study of hepatitis C virus (HCV) infection. We found that HCV infection was strongly associated with diabetes mellitus (adjusted odds ratio [OR], 2.9; 95% confidence interval [CI], 1.3-6.4) after controlling for age, race, unemployment, and body mass index. Among HIV-infected drug users, receipt of antiretroviral therapy (ART) for >1 year was also associated with diabetes (adjusted OR for receipt of ART without a protease inhibitor, 4.1 [95% CI, 1.1-15.5]; adjusted OR for receipt of ART including a protease inhibitor, 5.5 [95% CI, 1.5-20.4]).

Inman RD; Kornegay K. Exploring the lived experience of surviving with both alcoholism and diabetes. Journal of Addictions Nursing 15(2): 65-72, 2004. (17 refs.)

This phenomenological study explored the lived experiences of male alcoholics who also were diagnosed with diabetes. A convenience sample of five men between the ages of 53 and 75 years from the midwest was interviewed. Participants related in their own words their experiences of living with the dual diagnoses of alcoholism and diabetes. Data were analyzed by using Colaizzi's (1978) method of phenomenology. Nine themes were extracted from interview content that reflected such concepts as disease management, rationalization of unhealthy eating and drinking choices, viewing both diseases from a process perspective, familial inheritance, quality of life issues, consequences, support, motivation, and advice. Participants focused more on alcoholism than diabetes, perhaps because they had been alcoholics many more years than they had been diabetics. The limited emphasis in participant comments on how the two diseases interact with each other to influence health and one's quality of life indicates the need for health care providers to enhance their own understanding of this interactive process so they may more effectively promote a healthy lifestyle in this vulnerable population

Iso H; Date C; Wakai K; Fukui M; Tamakoshi A; JACC Study Group. The relationship between green tea and total caffeine intake and risk for self-reported type 2 diabetes among Japanese adults. Annals of Internal Medicine 144(8): 554-562, 2006. (22 refs.)

Background: in western populations, coffee consumption is associated with a reduced risk for type 2 diabetes; however, the effect of green, black, and oolong teas is unclear. Objective: To examine the relationship between consumption of these beverages and risk for diabetes. Design: Retrospective cohort study. Setting: 25 communities across Japan. Participants: A total of 17 413 persons (6727 men and 10 686 women; 49% of the original study population) who were 40 to 65 years of age; had no history of type 2 diabetes, cardiovascular disease, or cancer at the baseline lifestyle survey; and completed the 5-year follow-up questionnaire. There was no difference in body mass index levels at baseline between respondents and non-respondents. Measurements: Questionnaire on consumption of coffee; black, green, and oolong teas; and physician-diagnosed diabetes. Results: During the 5-year follow-up, there were 444 self-reported new cases of diabetes in 231 men and 213 women (5-year event rates, 3.4% and 2.0%, respectively). Consumption of green tea and coffee was inversely associated with risk for diabetes after adjustment for age, sex, body mass index, and other risk factors. Multivariable odds ratios for diabetes among participants who frequently drank green tea and coffee (6 cups of green tea per day and 3 cups of coffee per day) were 0.67 (95% Cl, 0.47 to 0.94) and 0.58 (Cl, 0.37 to 0.90), respectively, compared with those who drank less than I cup per week. No association was found between consumption of black or oolong teas and the risk for diabetes. Total caffeine intake from these beverages was associated with a 33% reduced risk for diabetes. These inverse associations were more pronounced in women and in overweight men. Limitations: Diabetes was self-reported, no data were available on consumption of soda, and the follow-up rate was low. Conclusions: Consumption of green tea, coffee, and total caffeine was associated with a reduced risk for type 2 diabetes.

Karam GA; Reisi M; Kaseb AA; Khaksari M; Mohammadi A; Mahmoodi M. Effects of opium addiction on some serum factors in addicts with non-insulin-dependent diabetes mellitus. Addiction Biology 9(1): 53-58, 2004. (32 refs.)

The aim of this study was to determine the effect of opium on biochemical parameters in addicts with non-insulin-dependent diabetes mellitus (NIDDM). Twenty-three males and 26 females between 35 and 65 years of age, with NIDDM, addicted to opium, were selected as the case group. Twenty-three males and 26 females with NIDDM and no opium addiction served as controls. Fasting glucose, glycated haemoglobin (HbA1c), total cholesterol, high density lipoproteins-cholesterol (HDL-c), triglycerides (TGs), sodium (Na+), potassium (K+), calcium (Ca2+), iron (Fe2+), total iron binding capacity (TIBC), serum total protein, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), uric acid and urea were measured in the serum of the two groups. Serum protein electrophoresis was also carried out. Compared to the control group, in addicted males with NIDDM, HbA1c, K+ and Fe2+ were higher, and serum total protein, ALT and HDL-c were lower. No significant difference was observed between other factors. Albumin was lower in addicts, but no significant difference was observed between the albumin/globulin ratios. In addicted females with NIDDM, serum total protein, TIBC, ALT and AST were lower compared to non-addicts. Cholesterol tends to be lower in diabetic addicted males, HbA1c in addicted females and uric acid in addicted males was higher compared to non-addicted diabetics. Their differences, however, were not significant. According to our results, smoking opium increases serum glucose and decreases HDL-c, and thus adds to metabolic disorders in NIDDM patients. It also increases potassium and Fe2+ in males and decreases TIBC in females, and could therefore potentially interfere with water and iron metabolism.

Khoury JC; Miodovnik M; Buncher CR; Rosenn BM; Khoury PR; Sibai BM. Is caffeine a risk factor for adverse pregnancy outcome in women with Type 1 diabetes mellitus? (meeting abstract). Diabetologia 46(Supplement 2): A253-A254, 2003. (0 refs.)

Kim O; Kim JH; Jung JH. Stress and cigarette smoking in Korean men with diabetes. Addictive Behaviors 31(5): 901-906, 2006. (21 refs.)

The purpose of the study was to investigate the level of stress and cigarette smoking behaviors in Korean men with diabetes and to exam the relationships among them. Data were collected using the questionnaire including background characteristics, modified Brief Encounter Psychosocial Instrument (BEPSI) and the Fagerstrom Tolerance Questionnaire (FTQ). 37% of the participants were current smokers with a mean of 4.22 FTQ score. 22% among the current smokers had a nicotine dependency. 43.1% indicated they were considering quitting smoking within 6 months. The level of stress was not associated with the amount of smoking. However, the level of stress was associated with nicotine dependency. There were no significant differences between the smoking cessation stage and stress. In conclusion, the prevalence of smoking among Korean men with diabetes is high. The large proportion of smokers in the contemplation and preparation stages should be supported by the need for stage-matched interventions targeting this special group of smokers.

Kokavec A; Crowe SF. Effect of moderate white wine consumption on serum IgA and plasma insulin under fasting conditions. Annals of Nutrition and Metabolism 50(5): 407-412, 2006. (50 refs.)

Background/Aims: The present study aims to investigate the contribution of alcohol toxicity to the development of malnutrition by assessing the effect of consuming a moderate amount of white wine on plasma insulin and serum IgA under fasting conditions. Methods: A total of 5 non-alcoholic males aged between 19 and 22 years participated in the current investigation. The experimental procedure required participants to undergo a 6-hour fast before ingesting 4 standard units of alcohol (40 g) in the form of white wine over a 120-min period. The level of blood alcohol, plasma insulin and serum IgA was assessed at 30-min intervals across the 120-min experimental period. Results: Consuming alcohol promotes a significant increase in serum IgA in the absence of any change in plasma insulin or ketone production in fasted individuals. Conclusion: White wine prior to a meal does not promote glucose metabolism and utilization and may increase the risk of developing a transient diabetic condition due to an alteration in energy metabolism.

Kroenke CH; Chu NF; Rifai N; Spiegelman D; Hankinson SE; Manson JE; Rimm EB. A cross-sectional study of alcohol consumption patterns and biologic markers of glycemic control among 459 women. Diabetes Care 26(7): 1971-1978, 2003. (42 refs.)

OBJECTIVE - Little research has explored associations of drinking patterns with glycemic control, especially among women. Our objective was to determine the relationship of patterns of alcohol consumption-including average daily consumption, weekly frequency of consumption, drinking with meals, and beverage type-with biologic markers of insulin resistance m young women. RESEARCH DESIGN AND METHODS - This study was cross-sectional in design. The subjects consisted of a stratified random subpopulation of 459 U.S. normal-weight and over-weight female nurses, 33-50 years of age, drawn from the Nurses' Health Study 11 and sampled for distinct drinking patterns. Women provided blood samples and detailed information on dietary and lifestyle factors between 1995 and 1999. The main outcome measures were fasting insulin, C-peptide, and HbA, c. RESULTS - Adjusting for age, smoking, physical activity, television watching, BMI, and several dietary factors, average alcohol intake was inversely associated with HbA,c (units in percentage of HbA,,): 0 g/day (reference = 5.36%), 0.1 to <5.0 g/day (-0.04%), 5.0 to <15.0 g/day (-0.09%), 15.0 to <25.0 g/day (-0.10%), and greater than or equal to25.0 g/day (-0.17%) (P value, test for trend <0.001). We found an inverse association of alcohol intake and insulin, but only for women with a BMI greater than or equal to25 kg/m(2). Specifically, insulin levels were lowest for episodic drinkers consuming greater than or equal to2 drinks per day on 0-3 days per week. Consumption with meals and type of alcoholic beverage did not further influence these results. CONCLUSIONS - Moderate alcohol consumption of 1-2 drinks per day on a few to several days of the week may have a beneficial glycemic effect, particularly among over-weight women.

Laing SP; Jones ME; Swerdlow AJ; Burden AC; Gatling W. Psychosocial and socioeconomic risk factors for premature death in young people with type 1 diabetes. Diabetes Care 28(7): 1618-1623, 2005. (18 refs.)

OBJECTIVE - Mortality from acute diabetes-related events is greatly raised in young adults with type 1 diabetes. Psychosocial and socioeconomic risk factors are examined for deaths front acute events separately from deaths due to other causes. RESEARCH DESIGN AND METHODS - This study had a nested case-controlled design, The cases were patients from the Diabetes UK cohort who died before age 40 years, Deaths were categorized as acute events or chronic conditions related to diabetes. Where possible, two matched control subjects were selected for each case. Data relating to psychosocial and socioeconomic factors and variables related to diabetes complications were extracted from the case notes. Risks of death were estimated by calculation of odds ratios (ORs). RESULTS - Case notes were obtained for 98 case and 137 control subjects. Fifty-one deaths were attributed to acute causes, 34 to chronic conditions related to diabetes, and the remaining 13 were unrelated to diabetes. Living alone (OR 4.4), past drug abuse (5.7), and previous psychiatric referral (4.6) were all significantly associated with death from acute event, but not death from chronic conditions. There was no association between deaths from acute events and nephropathy, hypertension, neuropathy, or retinopathy, although all of these were associated with deaths from chronic conditions. CONCLUSIONS - The results indicate that psychosocial factors are powerful risk factors for mortality from acute events in patients with type 1 diabetes, although not for mortality from chronic conditions. The data enable the identification of a high-risk group suitable for targeting with preventive measures to reduce acute event mortality.

Lane JD; Barkauskas CE; Surwit RS; Feinglos MN. Caffeine impairs glucose metabolism in type 2 diabetes. Diabetes Care 27(8): 2047-2048, 2004. (11 refs.)

Caffeine is a widely used drug despite evidence that it has deleterious consequences for health, including diabetes (1). In 1967, a study reported that drinking two cups of instant coffee significantly impaired glucose tolerance in a small group of men with "maturity-onset diabetes" (2). Recent studies showed that caffeine acutely decreased insulin sensitivity in young, nondiabetic adults (3-5). This study tested how oral caffeine affects carbohydrate metabolism in patients with type 2 diabetes, for whom decreases in insulin sensitivity might result in exaggerated hyperglycemic responses to glucose and other carbohydrates, which would aggravate the glycemic dysregulation found in the disease. We tested the effects of caffeine on fasting glucose and insulin levels and on glucose and insulin responses.

Lee P; Nicoll AJ; McDonough M; Colman PG. Substance abuse in young patients with type 1 diabetes: Easily neglected in complex medical management. Internal Medicine Journal 35(6): 359-361, 2005. (9 refs.)

The use of recreational drugs has become increasingly popular among young people. As a centre caring for a large group of young patients with type 1 diabetes, we have become concerned about the number of patients presenting with drug-related metabolic problems. We present a case series highlighting the issues of substance abuse in young patients with type 1 diabetes.

Leonardson GR; Kemper E; Ness FK; Koplin BA; Daniels MC; Leonardson GA. Validity and reliability of the AUDIT and CAGE-AID in northern plains American Indians. Psychological Reports 97(1): 161-166, 2005. (18 refs.)

According to the Indian Health Service, substance abuse and Type 2 diabetes are serious problems among Native Americans. To assess substance use in a medical setting, valid screening tests are needed so the Alcohol Use Disorders Identification Test (AUDIT), a simple brief screen for excessive drinking, and the CAGE-adapted to Include Drugs (CAGE-AID) for identifying primary care patients with alcohol and drug disorders were given 50 Northern Plains American Indians with diabetes. Both are short, easy to administer, have good sensitivity and specificity, and can be easily incorporated into a medical history protocol or intake procedure. Reliability coefficients were above .90 and appeared to have sufficient concurrent and divergent validity indicated by moderate correlations with the General Well-being Schedule (rs = -.39 and -.36), the Family-Adaptation, Partnership, Growth, Affection, & Resolve (r = -.47 and -.36), and the Beck Depression Inventory-II (r = .36 and .29).

Lidfeldt J; Nyberg P; Nerbrand C; Samsioe G; Schersten B; Agardh CD. Socio-demographic and psychosocial factors are associated with features of the metabolic syndrome. The Women's Health in the Lund Area (WHILA) study. Diabetes, Obesity and Metabolism 5(2): 106-112, 2003. (5 refs.)

Aim: The aim was to analyse any associations between socio-demographic and psychosocial factors and different features of the metabolic syndrome in a geographically well-defined population of middle-aged women. Methods: A population of 10 766 Caucasian women aged 50-59 years was investigated regarding biological and socio-demographic conditions, physical activity, dietary habits, aspects of quality of life, and subjective physical and mental symptoms. The screening instrument was used to discriminate subjects as positive or negative on one or more of a total of eight variables considered to be linked to the metabolic syndrome. The cut-off values for positive screening were non-fasting capillary blood glucose greater than or equal to 8.0 mmol/l and serum triglycerides greater than or equal to 2.3 mmo/l, BMI greater than or equal to 30 kg/m(2) , WHR greater than or equal to 0.90, blood pressure greater than or equal to 160 and/or 95 mmHg, a family history of diabetes, and pharmacological treatment for hypertension or hyperlipidaemia. Results: Altogether 6805 women (63.2%) participated: 3535 with positive and 3270 with negative screening. Multiple logistic regression analyses showed that comprehensive (OR 1.62, 95% CI 1.41-1.87) and upper secondary (1.40, 1.24-1.57) school, low physical quality of life (1.41, 1.23-1.61) and high sum of subjective physical symptoms (1.06, 1.04-1.08) were positively associated with one or more features of the metabolic syndrome, while high leisure-time exercise and healthy diet (0.84, 0.71-0.99), and low (less than or equal to 83 g/week) (0.71, 0.63-0.81) and moderate (84-167 g/week) (0.78, 0.65-0.93) alcohol consumption were negatively associated. Conclusions: To identify middle-aged women with cardiovascular risk factors and high risk for diabetes, it is important to consider not only biological, but also socio-demographic and psychosocial conditions.

Lu W; Jablonski KA; Resnick HE; Jain AK; Jones KL; Gottlieb AM et al. Alcohol intake and glycemia in American Indians: The Strong Heart Study. Metabolism: Clinical and Experimental 52(2): 129-135, 2003. (34 refs.)

The relationship between alcohol intake and glycemia and type 2 diabetes in American Indians aged 45-74 years was assessed using data from participants in the Strong Heart Study, a longitudinal study of 13 American Indian communities in three US geographic areas. Alcohol consumption was estimated from self-reports. Adjusted means of blood glucose for alcohol intake categories were estimated using analysis of covariance. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined by logistic regression to estimate the association between alcohol intake and type 2 diabetes in the cross-sectional analysis, and between alcohol intake and glucose intolerance using longitudinal data. Fasting and 2-hour plasma glucose concentrations showed an inverse J-shaped relationship with alcohol intake. In the cross-sectional analysis, light drinkers, compared to never drinkers, had a significantly lower risk of having diabetes (OR = 0.66; 95% CI, 0.44-0.99); among drinkers, heavy drinkers had a higher (but not significant) prevalence of diabetes. Longitudinal analysis showed no significant worsening of glucose tolerance across alcohol intake levels. Subanalyses stratified by body mass index (BMI) showed no differences between obese and non-obese participants in the relationship between alcohol intake and glucose tolerance. Alcohol intake did not appear to significantly increase the risk of worsening glucose tolerance. Thus alcohol intake does not appear to be a determinant of diabetes risk in this population.

Mackenzie T; Brooks B; O'Connor G. Beverage intake, diabetes, and glucose control of adults in America. Annals of Epidemiology 16(9): 688-691, 2006. (20 refs.)

PURPOSE: Beverages are important components of diet and a route for the intake of caffeine, ethanol, and other bioactive substances. The aim of the study is to examine the association between type of beverages consumed and glucose control in American adults with and without diabetes. METHODS: Diabetes status, glycosylated hemoglobin (hemoglobin A(1c) [HbA(1c)]) level, and 1-month recall food frequency questionnaires were all collected in the Third National Health and Nutrition Examination Survey (1988 to 1994), based on a nationally representative sample of the noninstitutionalized civilian US population. We used regression and other methods for clustered data to examine the association of HbA(1c) levels with self-reported intake of carbonated drinks, alcohol, coffee, tea, juices, and milk in participants aged 18 to 75 years with and without diabetes. RESULTS: Adults with diabetes reported drinking half the amount of alcohol as adults without diabetes. Compared with nondrinkers, subjects who had 30 or more drinks per month of alcohol had mean HbA(1c) levels 1.2 units less (P < 0.001) in persons with diabetes and 0.2% less (p < 0.001) in persons without diabetes. Adults with diabetes reported drinking three times as much diet soda as adults without diabetes. However, in adults with diabetes who had one or more drinks of diet soda per day, HbA(1c) level was 0.7 units greater (p < 0.001) compared with those who drank none. CONCLUSIONS: Alcohol consumption, at least in moderate amounts, correlates with better glucose control. There is a correlation between drinking diet soda and glucose control in adults with diabetes.

Mascitelli L; Pezzetta F. Alcohol use and diabetes mellitus. (letter). Annals of Internal Medicine 141(5): 409-409, 2004. (2 refs.)

This letter addresses an article published in the Annals 140 (3): 211-219, 2004, entitled "Effect of alcohol consumption on diabetes mellitus - A systematic review"

Mascitelli L; Pezzetta F. Anti-inflammatory action of alcohol and risk of type 2 diabetes mellitus. (letter). Archives of Internal Medicine 164(5): 572-572, 2004. (5 refs.)

McCulloch B; McDermott R; Miller G; Leonard D; Elwell M; Muller R. Self-reported diabetes and health behaviors in remote indigenous communities in northern Queensland Australia. Diabetes Care 26(2): 397-403, 2003. (30 refs.)

The associations between self-reported diabetes and smoking, alcohol consumption, fruit consumption, and participation in adequate exercise in communities in northern Queensland, Australia were studied, using data from the Well Persons' Health Check (WPHC). The WPHC was a cross-sectional survey conducted between March 1998 and October 2000. The research sample included 1,602 Aborigines, 1,074 Torres Strait Islanders, and 186 persons of joint descent over the age of 15 years (total n=2,862). The following results were seen: (1) a total of 32% of individuals with diabetes and 25% of other individuals reporting eating enough fruit, although the difference was not significant after adjustment for age, sex, and ethnicity; (2) report by 58% of participants who reported diabetes and 51% of others of adequate exercise, although the difference was not significant after adjustments; (3) report by 43% of individuals who reported diabetes and 72% of others of alcohol consumption, and the difference remained significant after adjustments; (4) consumption of alcohol at harmful levels at similar levels by both groups; and (5) tobacco smoking by 40% of those reporting diabetes and 63% of other persons, with those reporting diabetes significantly less likely to smoke tobacco than other participants after adjustments. It is suggested that indigenous individuals with diabetes, who live in rural and remote communities, may not be adopting lifestyle changes required for optimal self-management of their diabetes.

McGuire LC; Cruickshank AM; Munro PT. Alcoholic ketoacidosis. (review). Emergency Medicine Journal 23(6): 417-420, 2006. (23 refs.)

Alcoholic ketoacidosis (AKA) is a common reason for investigation and admission of alcohol dependent patients in UK emergency departments. Although well described in international emergency medicine literature, UK emergency physicians rarely make the diagnosis of AKA. There is increasing evidence that rather than being benign and self limiting, AKA may be a significant cause of mortality in patients with alcohol dependence. This literature review discusses the history, characterisation, pathophysiology, diagnosis, and management of AKA.

Meisinger C; Doring A; Thorand B; Lowel H. Association of cigarette smoking and tar and nicotine intake with development of type 2 diabetes mellitus in men and women from the general population: The MONICA/KORA Augsburg Cohort Study. Diabetologia 49(8): 1770-1776, 2006. (29 refs.)

Aims/hypothesis: We examined sex-specific associations between cigarette smoking and incident type 2 diabetes mellitus in Germany. Subjects, materials and methods: The study was based on 5,470 men and 5,422 women (aged 25-74 years) without diabetes who participated in one of the three population-based MONICA Augsburg surveys between 1984 and 1995. Incident cases of type 2 diabetes were assessed using follow-up questionnaires. Hazard ratios (HRs) were estimated from Cox proportional hazard models. Results: Up to 31 December 2002 a total of 409 cases of incident type 2 diabetes among men and 263 among women were registered. The number of cigarettes and the nicotine and tar consumption per day were associated with a significantly increased risk of type 2 diabetes among men, but not among women; this could be due to the low power of the study in women. After multivariable adjustment, the HRs for type 2 diabetes compared with never-smokers were 1.48, 2.03 and 2.10 for men smoking 1 to 14, 15 to 19 and >= 20 cigarettes/day (p for trend < 0.0001) and 1.25, 1.34 and 1.37 for women smoking 1 to 9, 10 to 19 and >= 20 cigarettes/day (p for trend 0.0985). Compared with never-smokers, the HRs for increasing tar intake in men (1-167, 168-259 and >= 260 mg/day) were 1.45, 2.32 and 2.07 (p for trend < 0.0001); the respective HRs in women (1-89, 90-194 and >= 195 mg/day) were 1.18, 1.57 and 1.24 (p for trend 0.1159). Conclusions/interpretation: Cigarette smoking is an important modifiable risk factor of type 2 diabetes particularly in men from the general population.

Nakanishi N; Takatorige T; Fukuda H; Shirai K; Li WJ; Okamoto M et al. Components of the metabolic syndrome as predictors of cardiovascular disease and type 2 diabetes in middle-aged Japanese men. Diabetes Research and Clinical Practice 64(1): 59-70, 2004. (47 refs.)

To determine whether the clustered features of the metabolic syndrome precede the 7 year incidence of cardiovascular disease (CVD) and type 2 diabetes, we examined 6182 Japanese male office workers aged 35-59 years without any history of CVD. The 5588 subjects without type 2 diabetes also constituted the nondiabetic cohort, and were re-examined over seven successive years. Components of the metabolic syndrome included glycemic disorder (type 2 diabetes for the risk of CVD and impaired fasting glucose for the risk of type 2 diabetes), systemic obesity, hypertension, dyslipidemia, proteinuria, and elevated white blood cell (WBC) count. After controlling for age, family history of diabetes, alcohol intake, and cigarette smoking, the multivariate-adjusted relative risk of incidence of CVD compared with absence of components was 3.18, 3.48, 12.55, and 14.15 (P for trend <0.001), for the presence of 1,2,3, and greater than or equal to4 components, respectively. The corresponding relative risks of incidence of type 2 diabetes were 1.92, 4.36, 6.44, and 15.08 (P for trend <0.001). In both non-smokers and current smokers, the multivariate-adjusted relative risks of incidence of CVD and type 2 diabetes increased as the number of components increased (P for trend <0.001 for all). Our findings indicate that clustered features of the metabolic syndrome are closely associated with development of CVD and type 2 diabetes in middle-aged Japanese.

Napoli R; Cozzolino D; Guardasole V; Angelini V; Zarra E; Matarazzo M. Red wine consumption improves insulin resistance but not endothelial function in type 2 diabetic patients. Metabolism: Clinical and Experimental 54(3): 306-313, 2005. (50 refs.)

Epidemiological studies have shown that red wine consumption is associated with less cardiovascular mortality in the general population and in the diabetic patients. To determine whether red wine improves insulin resistance in diabetic patients and to explore the relation between insulin sensitivity and endothelial function, we studied vascular reactivity and insulin-mediated glucose uptake in 9 type 2 diabetic patients before and after 2 weeks of red wine consumption (360 mL/d, wine-treated diabetics) and 8 type 2 diabetic patients who did not consume wine (control diabetics). Vascular reactivity was evaluated by plethysmography during intraarterial infusion of acetylcholine (Ach), sodium nitroprusside, and L-N-monomethylarginine. Forearm nitrite balance was measured during Ach infusion. Insulin sensitivity was measured by euglycemic hyperinsulinemic clamp at 1 mU/kg per minute. The basal forearm blood flow and the response to Ach, to sodium nitroprusside, and to L-N-monomethylarginine were unchanged both in the wine-treated and in the control diabetics. In contrast, insulin-mediated whole body glucose disposal improved by 43% after red wine consumption (from 2.79 +/- 0.4 to 4.02 +/- 0.5 mg/kg of lean body mass per minute, P = .02), but did not change in the control group. In conclusion, red wine consumption for 2 weeks markedly attenuates insulin-resistance in type 2 diabetic patients, without affecting vascular reactivity and nitric oxide production.

Okosun IS; Glodener M; Dever GEA. Diagnosed diabetes and ethnic disparities in adverse health behaviors of American women. Journal of the National Medical Association 95(7): 523-532, 2003. (46 refs.)

Despite higher rates of some high-risk lifestyle factors in non-Hispanic black women compared to non-Hispanic white women, no data exist examining the role of diagnosed diseases. Having diabetes diagnosed might motivate women and their providers to work together to lower the women's levels of behavioral risk factors. The purpose of this study was to determine the association between diagnosed diabetes and adverse health behaviors, including smoking, alcohol consumption, and sedentary lifestyle in non-Hispanic white (n = 270) and non-Hispanic black (n = 149) women with type 2 diabetes. Diagnosed diabetes was defined as answering "yes" to the Third US National Health and Nutrition Examination Survey question: "Have you ever been told by a doctor that you have diabetes or sugar diabetes?" Logistic regression analyses were used to determine the association of diagnosed diabetes with the adverse health behaviors. In this study, non-Hispanic black diabetic women had higher prevalences of smoking, sedentary lifestyle, and lower rates of diagnosed diabetes compared with non-Hispanic white women (P < 0.01). Relative to non-Hispanic diabetic white, non-Hispanic diabetic black was associated respectively with 25% and 58% increased odds of smoking and sedentary lifestyle, adjusting for diagnosed diabetes and other confounding variables. Approximately 15% of alcohol consumption and 13% excess sedentary lifestyle in non-Hispanic diabetic blacks were associated with their increased rates of diagnosed diabetes relative to non-Hispanic diabetic whites. These excesses in adverse health behaviors, however, were within what can be explained by chance variation. There were non-significant trends toward less smoking and more sedentary lifestyle. Thus, diabetic women with a diagnosis generally had a worse behavioral risk profile than those without a diagnosis even after controlling multiple confounders. This shows the need for physicians to educate their diabetic patients regarding benefits of exercise and smoking avoidance.

Panagiotakos DB; Pitsavos C. Passive smoking's role in diabetes: More evidence of the harmfulness of tobacco smoke. (editorial). British Medical Journal 332(7549): 1044-1045, 2006. (12 refs.)

Parillo M; Riccardi G. Diet composition and the risk of type 2 diabetes: Epidemiological and clinical evidence. (review). British Journal of Nutrition 92(1): 7-19, 2004. (135 refs.)

In the last 10 years nutritional research on diabetes has improved dramatically in terms of both number of studies produced and quality of methodologies employed. Therefore, it is now possible to attempt to provide the evidence on which nutritional recommendations for the 1 prevention of type 2 diabetes could be based. We therefore performed a literature search and, among the papers published in indexed journals, we selected relevant epidemiological (mostly prospective) and controlled intervention studies. Lifestyle factors that have, so far, been consistently associated with increased risk of type 2 diabetes are overweight and physical inactivity. However, recent evidence from epidemiological studies has shown that the risk of type 2 diabetes is also associated with diet composition, particularly with: (1) low fibre intake; (2) a high trans fatty acid intake and a low unsaturated: saturated fat intake ratio; (3) absence of or excess alcohol consumption. All these factors are extremely common in Western populations and therefore the potential impact of any intervention on them is large: indeed, > 90 % of the general population has one or more of these risk factors. The ability to correct these behaviours in the population is estimated to reduce the incidence of diabetes by as much as 87 %. Recent intervention studies have shown that type 2 diabetes can be prevented by lifestyle changes aimed at body-weight reduction, increased physical activity and multiple changes in the composition of the diet. Within this context, the average amount of weight loss needed is not large, about 5 % initial weight, which is much less than the weight loss traditionally considered to be clinically significant for prevention of type 2 diabetes. In conclusion, new emphasis on prevention by multiple lifestyle modifications, including moderate changes in the composition of the habitual diet, might limit the dramatic increase in incidence of type 2 diabetes envisaged worldwide.

Pedersen-Bjergaard U; Reubsaet JLE; Nielsen SL; Pedersen-Bjergaard S; Perrild H; Pramming S et al. Psychoactive drugs, alcohol, and severe hypoglycemia in insulin-treated diabetes: Analysis of 141 cases. American Journal of Medicine 118(3): 307-310, 2005. (27 refs.)

By systematically screening for alcohol and drugs, we identified a psychoactive substance in one third of blood samples from diabetic patients with severe hypoglycemia. Episodes of severe hypoglycemia are often complicated by a temporary memory deficit, and exposure to illicit drugs and alcohol is generally underreported. Therefore, reliance on a patient's own testimony has limited value, and independent biochemical verification is important. In a previous series of severe hypoglycemia, alcohol intake has been reported in 4% to 19% of episodes, similar to the frequency of positive blood alcohol screens in our study (17%). We found that psychoactive drugs were present in blood screens with a similar frequency (18%) as alcohol, divided evenly between pharmaceutical and illicit agents. Perhaps drug-induced impairment of cognitive function lessens the awareness of the need for self-treatment of hypoglycemia. Some drugs affect carbohydrate metabolism or glucose counterregulation. Alternatively, use of drugs and increased risk of severe hypoglycemia may share a common cause, such as less meticulous self-care. Finally, chronic use or abuse of drugs may lead to behavioral changes, such as irregular eating habits, which may increase the risk of severe hypoglycemia. People with diabetes are educated to understand the relation between alcohol consumption and the risk of severe hypoglycemia and to avoid excessive alcohol intake. It is possible that the younger diabetic patients in this study have instead been attracted to use psychoactive drugs that were not known to cause hypoglycemia.

Pereira MA; Parker ED; Folsom AR. Coffee consumption and risk of type 2 diabetes mellitus - An 11-year prospective study of 28 812 postmenopausal women. Archives of Internal Medicine 166(12): 1311-1316, 2006. (32 refs.)

Background: Coffee intake may be associated with reduced risk of type 2 diabetes mellitus because of minerals, phytochemicals, and antioxidants in coffee, but the role of caffeine is unclear. Our objective was to examine the association between total, caffeinated, and decaffeinated coffee intake, as assessed by food frequency questionnaire at baseline, and risk of incident type 2 diabetes mellitus. Methods: This prospective analysis of the Iowa Women's Health Study (1986-1997) included 28 812 postmenopausal women free of diabetes and cardiovascular disease in the general community. The main outcome measure was incident type 2 diabetes mellitus as determined by mailed questionnaire. Results: Coffee intake was categorized as 0, less than 1, 1 to 3, 4 to 5, and 6 or more cups per day. During 11 years of follow-up, there were 1418 incident cases of diabetes. Relative risks (RRs) were adjusted for a variety of demographic, adiposity, and lifestyle measures. Compared with women who reported 0 cups of coffee per day, women who consumed 6 or more cups per day had a 22% lower risk (RR = 0.78; 95% confidence interval [CI], 0.61-1.01) of diabetes (P for linear trend across categories, .06). This association appeared to be largely explained by decaffeinated coffee (RR = 0.67; 95% CI, 0.42-1.08; P for trend, .006) rather than regular coffee (RR = 0.79; 95% CI, 0.59-1.05; P for trend, .90). Intake of magnesium and phytate did not explain these associations. Intakes of caffeine from all sources was not associated with risk of diabetes. Conclusion: Coffee intake, especially decaffeinated, was inversely associated with risk of type 2 diabetes mellitus in this cohort of postmenopausal women.

Robinson LE; Savani S; Battram DS; McLaren DH; Sathasivam P; Graham TE. Caffeine ingestion before an oral glucose tolerance test impairs blood glucose management in men with type 2 diabetes. Journal of Nutrition 134(10): 2528 -2533, 2004. (37 refs.)

Caffeine ingestion negatively affects insulin sensitivity during an oral glucose tolerance test (OGTT) in lean and obese men, but this has not been studied in individuals with type 2 diabetes. We examined the effects of caffeine ingestion on insulin and glucose homeostasis in obese men with type 2 diabetes. Men (n = 12) with type 2 diabetes (age = 49 +/- 2 y, BMI = 32 +/- 1 kg/m(2)) underwent 2 trials, 1 wk apart, in a randomized, double-blind design. Each trial was conducted after withdrawal from caffeine, alcohol, exercise, and oral hypoglycemic agents for 48 h and an overnight fast. Subjects randomly ingested caffeine (5 mg/kg body weight) or placebo capsules and 1 h later began a 3 h 75 g OGTT. Caffeine increased (P < 0.05) serum insulin, proinsulin, and C-peptide concentrations during the OGTT relative to placebo. Insulin area under the curve was 25% greater (P < 0.05) after caffeine than after placebo ingestion. Despite this, blood glucose concentration was increased (P < 0.01) in the caffeine trial. After caffeine ingestion, blood glucose remained elevated (P < 0.01) at 3 h postglucose load (8.9 +/- 0.7 mmol/L) compared with baseline (6.7 +/- 0.4 mmol/L). The insulin sensitivity index was lower (14%, P = 0.02) after caffeine than after placebo ingestion. Overall, despite elevated and prolonged proinsulin, C-peptide, and insulin responses after caffeine ingestion, blood glucose was increased, suggesting an acute caffeine-induced impairment in blood glucose management in men with type 2 diabetes.

Rosengren A; Dotevall A; Wilhelmsen L; Thelle D; Johansson S. Coffee and incidence of diabetes in Swedish women: A prospective 18-year follow-up study. Journal of Internal Medicine 255(1): 89-95, 2004. (43 refs.)

Objectives. To examine the long-term incidence of diabetes in relation to coffee consumption in Swedish women. Design. Prospective longitudinal cohort study. Setting. City of Goteborg, Sweden. Subjects. A random population sample of 1361 women, aged 39-65 years, without prior diabetes or cardiovascular disease took part in a screening study in 1979-1981 with questionnaires, physical examination and blood sampling. Main outcome measures. The development of diabetes until 1999 was identified by questionnaires in a second screening and the Swedish hospital discharge register. Results. Altogether, there were 74 new cases of diabetes. The risk of developing diabetes was 475 per 100 000 person-years in women who consumed two cups of coffee or less per day, 271 in women who consumed three to four cups per day, 202 with a consumption of five to six cups per day, and 267 in drinkers of seven cups or more per day. Associated hazard ratios, after adjustment for age, smoking, low physical activity, education and body mass index were 0.55 (0.32-0.95), 0.39 (0.20-0.77) and 0.48 (0.22-1.06) for daily consumption of three to four, five to six and seven cups or more, respectively, with a consumption of less than two per day as reference. Additional adjustment for serum cholesterol and triglycerides attenuated the relation between coffee and diabetes slightly, indicating a possible mediating effect on the effect of coffee by serum lipids. Conclusions. The findings of the present study support the hypothesis that coffee consumption protects from the development of diabetes in women.

Sairenchi T; Iso H; Nishimura A; Hosoda T; Irie F; Saito Y et al. Cigarette smoking and risk of type 2 diabetes mellitus among middle-aged and elderly Japanese men and women. American Journal of Epidemiology 160(2): 158-162, 2004. (18 refs.)

For examination of sex- and age-specific relations between smoking and risk of type 2 diabetes mellitus, 39,528 nondiabetic men and 88,613 nondiabetic women aged 40-79 years who underwent health checkups in Ibaraki-ken, Japan, in 1993 were followed through 2002. Risk ratios for diabetes according to smoking habits were calculated using a Cox proportional hazards model. Compared with never smokers, the risk ratio for diabetes among current smokers, after adjustment for age, systolic blood pressure, antihypertensive mediation use, alcohol intake, parental history of diabetes, body mass index, fasting status, blood glucose concentration, total and high density lipoprotein cholesterol levels, and log-transformed triglyceride level, was 1.27 (95% confidence interval (CI): 1.16, 1.38) in men and 1.39 (95% CI: 1.20, 1.61) in women. The excess risk was more pronounced among men with a parental history of diabetes than among men without one. The excess risk among current smokers was observed in both age subgroups (40-59 and 60-79 years). Respective multivariate risk ratios for the age subgroups were 1.37 (95% CI: 1.18, 1.60) and 1.20 (95% CI: 1.08, 1.34) in men and 1.45 (95% CI: 1.18, 1.79) and 1.34 (95% CI: 1.09, 1.66) in women. Smoking was independently associated with increased risk of type 2 diabetes among both middle-aged and elderly men and women.

Saremi A; Hanson RL; Tulloch-Reid M; Williams DE; Knowler WC. Alcohol consumption predicts hypertension but not diabetes. Journal of Studies on Alcohol 65(2): 184-190, 2004. (23 refs.)

Objective: This study examines the associations between alcohol consumption, Type 2 diabetes and hypertension in a native American population. Method: Data were collected in a population-based cross-sectional and prospective study conducted on 3,789 individuals aged 20 years. Reported alcohol consumption was classified as never, occasional or <1 a day, 1-2 drinks a day, greater than or equal to3 drinks a day, and occasional heavy drinking. The prevalence and incidence of diabetes and hypertension by categories of alcohol intake were determined. Results: About 68% of men and 39% of women reported some degree of alcohol consumption. There was no association between alcohol consumption and prevalence or incidence of diabetes, but a positive, statistically significant association between blood pressure and alcohol consumption was found in both genders. After adjustment for age, body mass index (BMI) and diabetes in a proportional hazards model in men, moderate drinkers (occasional or <1 drink a day and 1-2 drinks a day combined) had 1.24 (95% confidence interval: 0.98-1.57) and occasional heavy drinkers had 1.49 (1.02-2.17) times the incidence of hypertension as nondrinkers. The corresponding estimates of hypertension incidence for women were 1.53 (1.29-1.83) for moderate drinking and 1.38 (0.81-2.36) for occasional heavy drinking. As only 1% of participants reported greater than or equal to3 drinks a day., this group was excluded from these analyses. Conclusions: Alcohol consumption did not affect the development of Type 2 diabetes, but it was associated with increased risk of hypertension, and this effect was independent of diabetes or BMI in both genders.

Shiri R; Hassani KF; Ansari M. Association between opium abuse and comorbidity in diabetic men. American Journal on Addictions 15(6): 468-472, 2006. (30 refs.)

The aims of this study were to determine the prevalence of opium abuse in diabetic men and to investigate its association with comorbidity. The study population was comprised of 312 consecutive diabetic men aged 20 years or older residing in the study area in 2005. The prevalence of self-reported opium abuse was 11.2%. Opium use was associated with low socioeconomic status, smoking, tea consumption, and a higher prevalence of erectile dysfunction (ED) and severe depression. The prevalence of severe depression was 22.8% among 35 men who used opium and 13.4% among 277 who did not use it. The prevalence of moderate or severe ED was 85.7% among opium users and 66.1% among non-users. The risk of ED was two times (95% CI 1.0-7.4) higher in opium users compared with nonusers.

2006, Taylor & Francis, Ltd.

Simmons D; Voyle JA. Reaching hard-to-reach, high-risk populations: Piloting a health promotion and diabetes disease prevention programme on an urban marae in New Zealand. Health Promotion International 18(1): 41-50, 2003. (34 refs.)

his paper proposes that, in the case of Maori, as a high risk population, conventional approaches are insufficient, and that increased consideration needs to be given to how the settings in which health education and services are offered may influence diabetes prevention and earlier diagnosis. We have investigated the potential utility of an urban marae and its member network as a setting for a lifestyle programme focused around diabetes prevention. The research included a cross sectional survey of behavioural and metabolic risk factors for type 2 diabetes and qualitative data collection as part of a formative and process evaluation of a lifestyle programme established at the marae. The programme attracted 436 participants. The majority knew little about diabetes, had low levels of vigorous activity and high intakes of fatty foods. A family history of diabetes was present in >40% of participants. Undiagnosed diabetes, high blood pressure, hypercholesterolaemia, obesity, smoking and self-reported excessive alcohol consumption were common. The advent of diabetes education, a healthy lifestyle support programme, and exercise sessions at the marae and connected venues served as the impetus for the marae community to take over the running of their own health promotion programme.

Smith B; Wingard DL; Smith TC; Kritz-Silverstein D; Barrett-Connor E. Does coffee consumption reduce the risk of type 2 diabetes in individuals with impaired glucose? Diabetes Care 29(11): 2385-2390, 2006. (48 refs.)

OBJECTIVE - The purpose of this study was to investigate the association between coffee intake and incident diabetes based on an oral glucose tolerance test (OGTT) and examine coffee habits in those with impaired glucose separately from those with normal glucose at baseline. RESEARCH DESIGN AND METHODS - In this prospective study, 9 10 adults aged >= 50 years without diabetes at baseline in 1984-1987 were followed to 1992-1996, an average of 8 years after assessment of coffee intake. Logistic regression models were adjusted for sex, age, physical activity, BMI, smoking, alcohol, hypertension, and baseline fasting plasma glucose. RESULTS - Past and current coffee drinkers had a reduced risk of incident diabetes (odds ratio 0.38 [95% CI 0.17-0.87] and 0.36 [0.19-0.68], respectively) compared with those who never drank coffee. The 317 participants with baseline impaired glucose who were past or current coffee drinkers were also at reduced risk for incident diabetes (0.31 [0.11-0.87] and 0.36 [0.16-0.83], respectively). CONCLUSIONS - This study confirms a striking protective effect of caffeinated coffee against incident diabetes and extends these findings to incident diabetes based on OGTT independent of multiple plausible confounders.

2006, American Diabetes Association

Tenenbaum A; Fisman EZ; Adler Y; Motro M; Boyko V; Behar S. Smoking and development of type 2 diabetes in patients with decreased functional capacity. International Journal of Cardiology 104(3): 275-281, 2005. (55 refs.)

Objective: Data regarding the possible contribution of cigarette smoking to development of type 2 diabetes are scarce and inconclusive. Patients with impaired functional capacity and diminished physical activity are prone to develop new diabetes. However, the role of smoking on diabetes incidence among these patients has not been specifically investigated. The present study was aimed to evaluate the association between cigarette smoking and development of type 2 diabetes in patients with coronary artery disease and decreased functional capacity over a 6.2-year follow-up period. Methods: The study sample comprised 630 nondiabetic patients aged 45-74 years, with a fasting blood glucose of <126 mg/dl and with impaired functional capacity (New York Heart Association functional class 11 and 111). The sample was classified into two groups: 1) non smokers (never and past smokers pooled together)-552 patients and 2) current smokers-78 patients. Results: Smokers were younger but they had a relatively unfavorable lipid profile (with respect to apolipoproteins A, triglyceride and HDL-cholesterol levels). No significant differences between the groups were found for weight, body mass index, total cholesterol and blood pressure. During the follow-up, development of new diabetes was recorded in 98 patients: in 80 (14.5%) non smokers and in 18 (23.1%) smokers, p=0.05. Among the non smokers, there were no significant differences in diabetes incidence between 357 past smokers and 195 never smokers: respectively, 48 (13.4%) and 32 (16.4%), p=0.34. In addition, all-cause mortality among the smokers (23.1%) was significantly higher than in non smokers (12.7%), p=0.01. Multivariate analysis identified current smoking as an independent predictor of increased risk of new diabetes development with a hazard ratio of 1.94 (95% confidence interval 1.16-3.25). Conclusions: Current smoking was associated with an independent two-fold increased risk for development of type 2 diabetes in patients with impaired functional capacity.

Tercyak KP; Beville KW; Walker LR; Prahlad S; Cogen FR; Sobel DO et al. Health attitudes, beliefs, and risk behaviors among adolescents and young adults with type 1 diabetes. Children's Health Care 34(3): 165-180, 2005. (41 refs.)

Decision making about engaging in health-promoting and health-compromising behaviors among adolescents and young adults with type I diabetes is an important but understudied topic. The purpose of this' study was to describe the health attitudes, beliefs, risk behaviors, and general psychological functioning of adolescents and young adults with diabetes and to compare these psychosocial aspects of health to those of adolescents and young adults without diabetes. Fifty-three adolescents and young adults with type 1 diabetes and 53 demographically matched controls were recruited from 2 pediatric teaching hospitals and administered a confidential self-report questionnaire consisting of individual survey items and standardized scales. Compared to healthy adolescents and young adults, adolescents and young adults with diabetes had more frequent thoughts about health and sickness, rated their health as poorer, viewed smoking as less addictive, reported greater symptoms of depression, and reported greater exposure to smoking in their households, but less smoking experimentation. Poorer metabolic control was associated with decreased physical activity. Additional research on the design and implementation of diabetes-specific, cardiovascular disorder and tobacco control programs for adolescents and young adults is warranted.

Terry PD; Weiderpass E; Ostenson CG; Cnattingius S. Cigarette smoking and the risk of gestational and pregestational diabetes in two consecutive pregnancies. Diabetes Care 26(11): 2994-2998, 2003. (30 refs.)

OBJECTIVE - Cigarette smoking during pregnancy may increase the risk of gestational diabetes mellitus (GDM) or pregestational diabetes mellitus (PDM). Smoking has been associated positively with hyperinsulinemia and insulin rest stance in experimental studies, although the association with diabetes remains unclear. To further explore this issue, we examined the association with smoking in the largest prospective cohort study of GDM and PDM to date. RESEARCH DESIGN AND METHODS - The study population comprised 212,190 women in the population-based Swedish Birth Registry who had their first and second deliveries between January 1987 and December 1995. Maternal characteristics were recorded in a standardized manner at the first prenatal visit, followed by a clinical examination and a standardized in-person interview to assess lifestyle habits. Women were categorized as nonsmokers, light smokers (one to nine cigarettes per day), or moderate-to-heavy smokers (at least 10 cigarettes per day). RESULTS - Women with GDM in their first pregnancy experienced an eight- to ninefold in risk of GDM or PDM in their second pregnancy. Cigarette smoking was not associated with increased risk of these conditions. Neither women who smoked during their first and second pregnancies nor those who commenced smoking between pregnancies had a higher risk of GDM or PDM than nonsmokers. CONCLUSIONS - Our findings do not support an association between cigarette smoking and risk of GDM or PDM in young women of childbearing age.

Tuomilehto J; Hu G; Bidel S; Lindstrom J; Jousilahti P. Coffee consumption and risk of type 2 diabetes mellitus among middle-aged Finnish men and women. Journal of the American Medical Association 291(10): 1213-1219, 2004. (44 refs.)

Context Only a few studies of coffee consumption and diabetes mellitus (DM) have been reported, even though coffee is the most consumed beverage in the world. Objective To determine the relationship between coffee consumption and the incidence of type 2 DM among Finnish individuals, who have the highest coffee consumption in the world. Design, Setting, and Participants A prospective study from combined surveys conducted in 1982, 1987, and 1992 of 6974 Finnish men and 7655 women aged 35 to 64 years without history of stroke, coronary heart disease, or DM at baseline, with 175682 person-years of follow-up. Coffee consumption and other study parameters were determined at baseline using standardized measurements. Main Outcome Measures Hazard ratios (HRs) for the incidence of type 2 DM were estimated for different levels of daily coffee consumption. Results During a mean follow-up of 12 years, there were 381 incident cases of type 2 DM. After adjustment for confounding factors (age, study year, body mass index, systolic blood pressure, education, occupational, commuting and leisure-time physical activity, alcohol and tea consumption, and smoking), the HRs of DM associated with the amount of coffee consumed daily (0-2, 3-4, 5-6, 7-9, greater than or equal to10 cups) were 1.00, 0.71 (95% confidence interval [CI], 0.48-1.05), 0.39 (95% CI, 0.25-0.60), 0.39 (95% CI, 0.20-0.74), and 0.21 (95% CI, 0.06-0.69) (P for trend <.001) in women, and 1.00, 0.73 (95% CI, 0.47-1.13), 0.70 (95% CI, 0.45-1.05), 0.67 (95% CI, 0.40-1.12), and 0.45 (95% CI, 0.25-0.81) (P for trend=.12) in men, respectively. In both sexes combined, the multivariate-adjusted inverse association was significant (P for trend <.001) and persisted when stratified by younger and older than 50 years; smokers and never smokers; healthy weight, overweight, and obese participants; alcohol drinker and nondrinker; and participants drinking filtered and nonfiltered coffee. Conclusion Coffee drinking has a graded inverse association with the risk of type 2 DM; however, the reasons for this risk reduction associated with coffee remain unclear.

van Dam RM. Coffee and type 2 diabetes: From beans to beta-cells. (review). Nutrition Metabolism and Cardiovascular Diseses 16(1): 69-77, 2006. (70 refs.)

Coffee consumption has been associated with improved glucose tolerance and a lower risk of type 2 diabetes in diverse populations in the U.S., Europe, and Japan. This review discusses the strength of the evidence, relevant mechanisms, possible implications, and directions for further research. The finding that higher consumption of decaffeinated coffee was associated with a lower risk of type 2 diabetes suggests that coffee constituents other than caffeine play a role. Coffee is a source of several compounds that improved glucose metabolism in animal. studies, including the chlorogenic acids and lignans. Further research on phytochemicals in coffee may lead to the identification of novel mechanisms for effects of diet on the development of type 2 diabetes. In addition, knowledge on effects of coffee components may aid in the development or selection of types of coffee with improved health effects. Longer-term randomized intervention studies that test the effects of coffee consumption on glucose tolerance are warranted. Physical activity and weight management should be the mainstay of public health strategies to prevent type 2 diabetes. For individual choices regarding coffee consumption, potential effects of coffee on various health outcomes should be considered.

van Dam RM; Hu FB. Coffee consumption and risk of type 2 diabetes: A systematic review. (review). Journal of the American Medical Association 294(1): 97-104, 2005. (62 refs.)

Context: Emerging epidemiological evidence suggests that higher coffee consumption may reduce the risk of type 2 diabetes. Objective To examine the association between habitual coffee consumption and risk of type 2 diabetes and related outcomes. Data Sources and Study Selection We searched MEDLINE through January 2005 and examined the reference lists of the retrieved articles. Because this review focuses on studies of habitual coffee consumption and risk of type 2 diabetes, we excluded studies of type 1 diabetes, animal studies, and studies of short-term exposure to coffee or caffeine, leaving 15 epidemiological studies (cohort or cross-sectional). Data Extraction: Information on study design, participant characteristics, measurement of coffee consumption and outcomes, adjustment for potential confounders, and estimates of associations was abstracted independently by 2 investigators. Data Synthesis: We identified 9 cohort studies of coffee consumption and risk of type 2 diabetes, including 193 473 participants and 8394 incident cases of type 2 diabetes, and calculated summary relative risks (RRs) using a random-effects model. The RR of type 2 diabetes was 0.65 (95% confidence interval [CI], 0. 54-0.78) for the highest (>= 6 or >= 7 cups per day) and 0.72 (95% Cl, 0.62-0.83) for the second highest (4-6 cups per day) category of coffee-consumption compared with the lowest consumption category (0 or <= 2 cups per day). These associations did not differ substantially by sex, obesity, or region (United States and Europe). In the cross-sectional studies conducted in northern Europe, southern Europe, and Japan, higher coffee consumption was consistently associated with a lower prevalence of newly detected hyperglycemia, particularly postprandial hyperglycemia. Conclusions: This systematic review supports the hypothesis that habitual coffee consumption is associated with a substantially lower risk of type 2 diabetes. Longer-term intervention studies of coffee consumption and glucose metabolism are warranted to examine the mechanisms underlying the relationship between coffee consumption and type 2 diabetes.

van Dam RM; Willett WC; Manson JE; Hu FB. Coffee, caffeine, and risk of type 2 diabetes: A prospective cohort study in younger and middle-aged US women. Diabetes Care 29(2): 398-403, 2006. (30 refs.)

OBJECTIVE - High habitual coffee consumption has been associated with a lower risk of type 2 diabetes, but data on lower levels of consumption and on different types of coffee are sparse. RESEARCH DESIGN AND METHODS - This is a prospective cohort study including 88,259 U.S. women of the Nurses' Health Study II aged 26-46 years without history of diabetes at baseline. Consumption of coffee and other caffeine-containing foods and drinks was assessed in 1991, 1995, and 1999. We documented 1,263 incident cases of confirmed type 2 diabetes between 1991 and 2001. RESULTS - After adjustment for potential confounders, the relative risk of type 2 diabetes was 0.87 (95% CI 0.73 - 1.03) for one cup per day, 0.58 (0.49 - 0.68) for two to three cups per day, and 0.53 (0.41 - 0.68) for four or more cups per day compared with nondrinkers (P for trend < 0.0001). Associations were similar for caffeinated (0.87 [0.83 - 0.91] for a one-cup increment per day) and decaffeinated (0.81 [0.73 - 0.90]) coffee and for filtered (0.86 [0.82 - 0.90]) and instant (0.83 [0.74 - 0.93]) coffee. Tea consumption was not substantially associated with risk of type 2 diabetes (0.88 [10.64 - 1.23] for four or more versus no cups per day; P for trend = 0.81). CONCLUSIONS - These results suggest that moderate consumption of both caffeinated and decaffeinated coffee may lower risk of type 2 diabetes in younger and middle-aged women. Coffee constituents other than caffeine may affect the development of type 2 diabetes.

van de Wiel A. Diabetes mellitus and alcohol. (review). Diabetes/Metabolism Research and Reviews 20(4): 263-267, 2004. (50 refs.)

Alcohol influences glucose metabolism in several ways in diabetic patients as well as in non-diabetic patients. Since alcohol inhibits both gluconeogenesis and glycogenolysis, its acute intake without food may provoke hypoglycaemia, especially in cases of depleted glycogen stores and in combination with sulphonylurea. Consumed with a meal including carbohydrates, it is the preferred fuel, which may initially lead to somewhat higher blood glucose levels and hence an insulin response in type 2 diabetic patients. Depending on the nature of the carbohydrates in the meal, this may be followed by reactive hypoglycaemia. Moderate consumption of alcohol is associated with a reduced risk of atherosclerotic disorders. Diabetic patients benefit from this favourable effect as much as non-diabetic patients. Apart from effects on lipid metabolism, haemostatic balance and blood pressure, alcohol improves insulin sensitivity. This improvement of insulin sensitivity may also be responsible for the lower incidence of type 2 diabetes mellitus reported to be associated with light-to-moderate drinking. in case of moderate and sensible use, risks of disturbances in glycaemic control, weight and blood pressure are limited. Excessive intake of alcohol, however, may not only cause loss of metabolic control, but also annihilate the favourable effects on the cardiovascular system.

van; Dam RM; Dekker JM; Nijpels G; Stehouwer CDA; Bouter LM; Heine RJ. Coffee consumption and incidence of impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes: The Hoorn Study. Diabetologia 47(12): 2152-2159, 2004. (51 refs.)

Aims/hypothesis. Coffee contains several substances that may affect glucose metabolism. The aim of this study was to evaluate the relationship between habitual coffee consumption and the incidence of IFG, IGT and type 2 diabetes. Methods. We used cross-sectional and prospective data from the population-based Hoorn Study, which included Dutch men and women aged 50 - 74 years. An OGTT was performed at baseline and after a mean follow-up period of 6.4 years. Associations were adjusted for potential confounders including BMI, cigarette smoking, physical activity, alcohol consumption and dietary factors. Results. At baseline, a 5 cup per day higher coffee consumption was significantly associated with lower fasting insulin concentrations (- 5.6%, 95% CI - 9.3 to - 1.6%) and 2-h glucose concentrations (- 8.8%, 95% CI - 11.8 to - 5.6%), but was not associated with lower fasting glucose concentrations (- 0.8%, 95% CI - 2.1 to 0.6%). In the prospective analyses, the odds ratio (OR) for IGT was 0.59 (95% CI 0.36 - 0.97) for 3 - 4 cups per day, 0.46 (95% CI 0.26 - 0.81) for 5 - 6 cups per day, and 0.37 (95% CI 0.16 - 0.84) for 7 or more cups per day, as compared with the corresponding values for the consumption of 2 or fewer cups of coffee per day (p= 0.001 for trend). Higher coffee consumption also tended to be associated with a lower incidence of type 2 diabetes (OR 0.69, CI 0.31 - 1.51 for greater than or equal to 7 vs less than or equal to 2 cups per day, p= 0.09 for trend), but was not associated with the incidence of IFG (OR 1.35, CI 0.80 - 2.27 for greater than or equal to 7 vs less than or equal to 2 cups per day, p= 0.49 for trend). Conclusions/interpretation. Our findings indicate that habitual coffee consumption can reduce the risk of IGT, and affects post-load rather than fasting glucose metabolism.

Wakabayashi I; Masuda H. Influence of drinking alcohol on atherosclerotic risk in alcohol flushers and non-flushers of oriental patients with type 2 diabetes mellitus. Alcohol and Alcoholism 41(6): 672-677, 2006. (36 refs.)

Aims: Facial flushing caused by alcohol drinking is a typical symptom of high sensitivity to alcohol in orientals. We investigated whether drinking alcohol influences atherosclerotic risk factors in alcohol flushers and non-flushers in patients with diabetes mellitus. Methods: A cross-sectional study was performed using 225 subjects with type 2 diabetes. Sensitivity to alcohol was surveyed by a questionnaire on facial flushing. Subjects were divided into three groups by average amount of alcohol drinking (non-drinkers; light drinkers: < 140 g/week; heavy drinkers: 140 g/week or more). Results: Systolic blood pressure and blood HDL cholesterol were significantly higher in heavy drinkers than in non-drinkers. There were no significant differences in body mass index, blood pressure, blood total cholesterol, HDL cholesterol, uric acid, fibrinogen and sialic acid levels in flushers and non-flushers. In alcohol flushers, diastolic blood pressure and HDL cholesterol in heavy drinkers were significantly higher than those in non-drinkers, and systolic blood pressure was significantly higher in heavy drinkers than in non-drinkers and light drinkers. On the other hand, blood pressure and HDL cholesterol in non-flushers were not significantly different among non-, light and heavy drinkers. Serum total cholesterol was not significantly different among the three drinking groups both in flushers and non-flushers. Conclusions: Blood pressure and HDL cholesterol are more prone to be affected by drinking in flushers than in non-flushers, suggesting that alcohol sensitivity evaluated by flushing response due to drinking alcohol should be taken into account when the effects of alcohol drinking on atherosclerotic risk factors are considered in oriental patients with type 2 diabetes mellitus.

2006, Medical Council on Alcohol

Wang CS; Wang ST; Yao WJ; Chang TT; Chou P. Community-based study of hepatitis C virus infection and type 2 diabetes: An association affected by age and hepatitis severity status. American Journal of Epidemiology 158(12): 1154-1160, 2003. (35 refs.)

Past studies of the relation between hepatitis C virus (HCV) infection and type 2 diabetes conflict. The authors aimed to elucidate the relation by using a large community-based sample with a wide range of liver conditions. Between October 1997 and February 1998, 2,327 consecutive subjects (aged greater than or equal to35 years) were enrolled at the public health facility in Taiwan. Blood sugar, hepatitis B surface antigen, and antibody for HCV (anti-HCV) were tested. Abdominal sonography was performed on viral-hepatitis-positive subjects. In univariate analysis, older age, lower educational levels, sedentary work, body mass index of greater than or equal to25 kg/m(2), and anti-HCV positivity were significantly associated with type 2 diabetes (p < 0.05), but smoking, alcohol consumption, gender, and hepatitis B surface antigen status were not. In multivariate logistic regression, anti-HCV positivity was strongly associated with type 2 diabetes in subjects aged 35-49 years (odds ratio (OR) = 3.3, 95% confidence interval (CI): 1.4, 8.0) and 50-64-years (OR = 1.6, 95% CI: 1.1, 2.5). Sonographic evidence of fatty liver (OR = 2.4, 95% CI: 1.2, 4.8) and chronic liver disease (OR = 2.0, 95% CI: 1.0, 4.2) in anti-HCV-positive subjects was moderately associated with type 2 diabetes after age and gender adjustment. Data suggest that HCV infection is moderately associated with type 2 diabetes; the association was strongest for subjects aged 35-49 years and increased with severity of the liver condition.

Wannamethee SG; Camargo CA; Manson JAE; Willett WC; Rimm EB. Alcohol drinking patterns and risk of type 2 diabetes mellitus among younger women. Archives of Internal Medicine 163(11): 1329-1336, 2003. (33 refs.)

Objective: To examine the relationship between alcohol consumption and the incidence of type 2 diabetes mellitus among relatively young and middle-aged women. Methods: In a prospective study, 109 690 women, aged 25 to 42 years, without a history of coronary heart disease, stroke, cancer, or diabetes mellitus completed a detailed lifestyle and medical history questionnaire in 1989. During 10 years of follow-up, we documented 935 incident cases of type 2 diabetes mellitus. Results: We found a nonlinear relationship between alcohol consumption and risk of type 2 diabetes mellitus after adjustment for multiple confounders, including body mass index, smoking, physical activity, and family history of diabetes mellitus (quadratic trend P=.003). Compared with lifelong abstainers, the adjusted relative risks (95% confidence intervals) were 0.80 (0.66-0.96) for those consuming 0.1 to 4.9 g/d, 0.67 (0.50-0.89) for those consuming 5.0 to 14.9 g/d, 0.42 (0.20-0.90) for those consuming 15.0 to 29.9 g/d, and 0.78 (0.34-1.78) for those consuming 30.0 g/d or more. Further adjustment for dietary factors, including glycemic load, trams-fatty acid, polyunsaturated fat, and total fiber intake, did not appreciably alter these findings. The inverse association with light to moderate drinking was most apparent in women who reported wine or beer drinking. Women who reported 30.0 g/d or more of liquor intake showed a significantly increased risk of diabetes mellitus compared with those who did not report liquor intake (adjusted relative risk, 2.50; 95% confidence interval, 1:00-6.23). Conclusion: Light to moderate alcoholic beverage consumption may be associated with a lower risk of type 2 diabetes mellitus among women aged 25 to 42 years, although this benefit.may not- persist at higher levels.

Wu TY; Hankinson SE; Willett WC; Giovannucci E. Caffeinated coffee, decaffeinated coffee, and caffeine in relation to plasma C-peptide levels, a marker of insulin secretion, in US women. Diabetes Care 28(6): 1390-1396, 2005. (37 refs.)

OBJECTIVE - Coffee consumption is associated with reduced risk of type 2 diabetes, but the mechanism is not clearly understood. Elevated C-peptide, as a marker of insulin secretion, has been linked to insulin-resistant type 2 diabetes. In this study, we examined consumption of caffeinated and decaffeinated coffee and total caffeine in relation to concentrations of plasma C-peptide. RESEARCH DESIGN AND METHODS - Plasma C-peptide concentrations were measured in a cross-sectional setting among 2,112 healthy women from the Nurses' Health Study I who provided blood samples in 1989-1990. Consumption of caffeinated and decaffeinated coffee and total caffeine was assessed using a semiquantitative food-frequency questionnaire in 1990. RESULTS - intakes of caffeinated and decaffeinated coffee and caffeine in 1990 were each inversely associated with C-peptide concentration in age-adjusted, BMI-adjusted, and multivariable-adjusted analyses. In multivariable analysis, concentrations of C-peptide were 16% less in women who drank and greater than 4 cups/day of caffeinated or decaffeinated coffee compared with nondrinkers (P less than 0.005 for each). Women in the highest quintile compared with the lowest quintile of caffeine intake had 10% lower C-pepticle levels (P = 0.02). We did not find any association between tea and C-peptide. The inverse association between caffeinated coffee and C-peptide was considerably stronger in obese (27% reduction) and overweight women (20% reduction) than in normal weight women (11% reduction) (P = 0.005). CONCLUSIONS - Our findings suggest a potential reduction of insulin secretion by coffee in women. This reduction may be related to other components in coffee rather than caffeine.

Yuan JM; Govindarajan S; Arakawa K; Yu MC. Synergism of alcohol, diabetes, and viral hepatitis on the risk of hepatocellular carcinoma in blacks and whites in the US. Cancer 101(5): 1009-1017, 2004. (41 refs.)

BACKGROUND. Heavy alcohol consumption, viral hepatitis, and diabetes are risk factors for hepatocellular carcinoma (HCC). However, to the authors' knowledge, the information concerning their interaction effect in patients with risk of HCC is sparse. METHODS. A population-based, case-control study of HCC was conducted during 1984-2002. The study involved 295 HCC cases and 435 age-, gender-, and race-matched control subjects among Hispanic and non-Hispanic whites and blacks in Los Angeles County, California. Lifestyle risk factors were ascertained through in-person interviews. Infections with the hepatitis B and C (HCV) viruses were determined using their serologic markers. RESULTS. Fourteen HCC cases but no control subjects tested positive for the hepatitis B surface antigen. Seropositivity for antibodies to HCV was associated with an odds ratio (OR) of 125 (95% confidence interval [95% CI], 17-909) for HCC, whereas seropositivity for antibodies to the hepatitis B core antigen was related to an OR of 2.9 (95% Cl, 1.7-5.0). Heavy alcohol consumption and cigarette smoking were found to be independently associated with a statistically significant two to threefold increase in risk of HCC after adjustment for hepatitis B and C serology. Subjects with a history of diabetes had an OR of 2.7 (95% Cl, 1.6-4.3) for HCC compared with nondiabetic subjects. A synergistic interaction on HCC risk was observed between heavy alcohol consumption and diabetes (OR = 4.2; 95% Cl, 2.6-5.8), heavy alcohol consumption and viral hepatitis (OR = 5.5; 95% Cl, 3.9-7.0), or between diabetes and viral hepatitis (OR = 4.8; 95% Cl, 2.7-6.9). CONCLUSIONS. Heavy alcohol consumption, diabetes, and viral hepatitis were found to exert independent and synergistic effects on risk of HCC in U.S. blacks and whites.

Yugar-Toledo JC; Tanus-Santos JE; Sabha M; Sousa MG; Cittadino M; Tacito LHB et al. Uncontrolled hypertension, uncompensated type II diabetes, and smoking have different patterns of vascular dysfunction. Chest 125(3): 823-830, 2004. (50 refs.)

Study objectives: We evaluated the vascular reactivity in healthy subjects, heavy smokers, uncompensated type II diabetics, and patients with uncontrolled essential hypertension. Plasma nitrite/nitrate, cyclic 3',5'-guanosine monophosphate (cGMP), and thromboxane (TX)-B-2 levels were measured. Participants: One hundred participants were classified into four groups: normal control subjects (n = 25), heavy smokers (n = 25), uncompensated type II diabetics (n = 25), and patients with uncontrolled essential hypertension (n = 25).Interventions: The brachial artery diameter was measured by a high-resolution ultrasound technique before and after reactive hyperemia and glyceryl trinitrate (GTN), 0.4 mg, administration. Plasma nitrite/nitrate, cGMP, and TX-B-2 levels were also measured. Results: Heavy smokers, uncompensated type II diabetics, and uncontrolled hypertensive patients showed impaired endothelium-dependent, nitric oxide (NO) flow-mediated vasodilatation (8.0 +/- 2.5%, 5.8 +/- 2.7%, and 7.2 +/- 3.3%, respectively [mean +/- SD]) when compared to the control subjects (12.6 +/- 3.6%; p < 0.01). Smokers had a normal endothelium-independent function induced by NO donor (GTN) [25.0 +/- 7.3% vs 25.3 +/- 8.5% for control subjects]. Uncompensated type II diabetics and patients with uncontrolled hypertension had impaired endothelium-independent responses (17.7 +/- 7.1% and 16.8 +/- 6.9%, respectively, vs 25.3 +/- 8.5 for normal control subjects; p < 0.05). Plasma levels of cGMP and TX-B-2 were not significantly different in the four groups, but nitrite/nitrate concentrations were increased in diabetics compared to the control subjects (266 +/- 47 mumol/L vs 98 +/- 18 mumol/L, p < 0.05). Conclusion: Both uncontrolled hypertension and type II diabetes mellitus, but not smoking, are associated with impaired vascular smooth-muscle reactivity induced by NO donors. However, only uncompensated type II diabetics showed an increase in plasma nitrite/nitrate levels, suggesting an association with excessive production and/or inactivation of NO.

Zilkens RR; Burke V; Watts G; Beilin LJ; Puddy IB. Effect of alcohol intake on insulin sensitivity in men. Diabetes Care 26(3): 608-612, 2003. (33 refs.)

The objective was to determine whether reducing alcohol intake in moderate-to-heavy drinkers (40-110 g/day) results in improvement in insulin sensitivity. A 4-week run-in period where subjects maintained their usual drinking pattern was followed by randomization to a two-way crossover intervention study. In each of two 4-week treatment interventions, subjects either substituted their usual alcohol intake with a 0.9% alcohol beer or maintained their usual alcohol intake. At the end of each 4-week period, insulin sensitivity as determined by the low-dose insulin glucose infusion test and the homeostasis model assessment (HOMA) score, and biomarkers of alcohol consumption (gamma-glutamyl transpeptidase [GGT] and high-density lipoprotein (HDL) cholesterol) were measured. A total of 16 healthy men, mean age 51.0 years, with a mean body mass index of 26.4 completed the study. There was a large reduction in alcohol intake (72.4 vs. 7.9 g/day, p <0.001) and significant reductions in GGT (geometric mean 24.4 units/l vs. 18.6 units/l; p <0.01) and HDL cholesterol (1.36 vs. 1.13 mmol/l, p <0.001). There was no effect of alcohol on insulin sensitivity index (ISI), fasting insulin, glucose, or HOMA score. Thus a substantial reduction in alcohol intake from 7.2 to 0.8 standard drinks a day in healthy men did not change insulin sensitivity as measured by ISI or HOMA score.

Zilkens RR; Puddey IB. Alcohol and type 2 diabetes: Another paradox? Journal of Cardiovascular Risk 10(1): 25-30, 2003. (10 refs.)

The French Paradox relates to the observation that mortality rates due to coronary heart disease are relatively low in France despite a diet rich in saturated fats. Another paradox linked to alcohol is the diverse associations of acute and chronic alcohol use with respect to insulin resistance, incidence of type 2 diabetes and incidence of cardiovascular disease in type 2 diabetes. Reports consistently suggest that the acute affects of alcohol induce a state of insulin resistance following either an oral and/or intravenous glucose load. Contrary to the acute alcohol studies is a large body of epidemiological evidence from cross-sectional studies which suggests that long-term exposure to alcohol is associated with an improvement in insulin sensitivity. Furthermore, a substantial number of prospective studies point to a protective role for light to moderate chronic alcohol intake against the development of diabetes as well as a protective effect of regular mild to moderate drinking against coronary artery disease in type 2 diabetic subjects.