A review of the challenges, glycaemic risks and self‐care for people with type 1 diabetes when consuming alcoholic beverages

Abstract

Evidence‐based information for people with type 1 diabetes mellitus (T1DM) when consuming alcoholic beverages is sparse and simplistic. In clinical practice, erratic blood glucose levels with hypoglycaemia and hyperglycaemia are regularly observed, with episodes of severe hypoglycaemia being a potential risk. Preventative health behaviour strategies are often based on trial and error, with deliberately caused hyperglycaemia being a common tactic. Although important, there are no systematic reviews that synthesise the research evidence on the acute effects of alcohol on blood glucose and the impact in real‐life. We aimed to investigate the acute effect of alcoholic beverages on blood glucose, and to use appropriate evidence to recommend self‐care advice to help maintain safe glycaemic control in people with T1DM. A literature search from eight bibliographic databases was performed. Fifteen appropriate publications were identified. Most original research was performed in a laboratory environment and demonstrated inconsistencies in the effects of alcohol on blood glucose. Few studies were conducted in the real‐life environment, with advice from ‘diabetes associations’ focusing on abstinence rather than alcohol harm reduction strategies. In conclusion, key components to consider when designing future interventions include: the biochemical response to alcohol; the role of exogenous insulin; the presence and timing of carbohydrate foodstuffs in relation to alcohol; the impact of the constituents and amount of an alcoholic beverage consumed; and the effects of alcohol on cognition and behaviours.

Demographic and socioeconomic patterns in the risk of alcohol‐related hospital admission in children and young adults with childhood onset type‐1 diabetes from a record‐linked longitudinal population cohort study in Wales

“…34 A recent systematic review on preventing alcohol-induced hypoglycaemia in T1D suggested a limited evidence base to inform clinical practitioners and that the advice provided by most national diabetes associations is therefore based on best clinical practice alone. 6,35 However, an observational study in adolescents has suggested a reduced risk of hypoglycaemia when drinking alcohol with eating meals or snacks. 14 An alternative possible interpretation of our findings is that paediatricians have a lower threshold for admitting teenagers aged 14 to 17 years with T1D who have been drinking alcohol because of excessive clinical concerns about these young people being at increased risk of the acute metabolic complications of alcohol ingestion such as hypoglycaemia.…”

“…Prohibitionist approaches seem ineffective in this age group who report being more likely to respond to motivating healthcare professionals who promote accepting, responsive and person‐centred relationships 34 . A recent systematic review on preventing alcohol‐induced hypoglycaemia in T1D suggested a limited evidence base to inform clinical practitioners and that the advice provided by most national diabetes associations is therefore based on best clinical practice alone 6,35 . However, an observational study in adolescents has suggested a reduced risk of hypoglycaemia when drinking alcohol with eating meals or snacks 14 …”

ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes

“…Consequences of alcohol consumption in T1D can include moderate or severe hypoglycemia due to suppression of gluconeogenesis, impaired growth hormone response, alcohol‐induced hypoglycemia unawareness, and increased risk of delayed hypoglycemia for 8–12 h after drinking alcohol 72 . Hyperglycemia is another consequence that can be related to drinking and occurs when consuming alcoholic beverages that are high in sugar, or by consuming additional carbohydrate before and after drinking to prevent hypoglycemia 71,73 …”

“…In young people with T1D, drinking alcohol can contribute to a range of additional health risks, including hypoglycemia and/or hyperglycemia, making them more vulnerable to alcohol‐related harms than youth without diabetes 71 . Consequences of alcohol consumption in T1D can include moderate or severe hypoglycemia due to suppression of gluconeogenesis, impaired growth hormone response, alcohol‐induced hypoglycemia unawareness, and increased risk of delayed hypoglycemia for 8–12 h after drinking alcohol 72 .…”

Association Between a Low Carbohydrate Diet, Quality of Life, and Glycemic Control in Australian Adults Living With Type 1 Diabetes: Protocol for a Mixed Methods Pilot Study

“…The meal plan contains no more than 100 g per day of dietary carbohydrate, making this intervention a low carbohydrate dietary regimen according to Feinman et al's [16] 2015 definition. Alcohol influences blood glucose levels, food and fluid choices, and quantities consumed [66]. For this reason, participants will be strongly advised to abstain from alcohol consumption during the 12-week intervention.…”