Alcohol consumption patterns in young adults with type 1 diabetes: The SEARCH for diabetes in youth study

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Abstract

Aims

The objective of this study is to describe alcohol consumption behaviors of young adults with T1D and to examine associations between alcohol consumption and diabetes-related clinical markers.

Methods

Data from 602 SEARCH for Diabetes in Youth Study participants age ≥ 18 yrs. with T1D were collected from 12/2011 to 6/2015 (50% female, mean age 21.3(SD 2.4), 22% race/ethnic minority). Participants were characterized as alcohol non-drinkers (n = 269), drinkers but non-binge drinkers (n = 167), or binge drinkers (n = 166) based on reported consumption in the past 30 days. Analyses were conducted using one-way ANOVAs, chi-square tests, and logistic regression modeling to examine associations between drinking and clinical markers.

Results

Fifty-five percent of participants reported alcohol consumption; 27.6% of participants reported binge drinking. After adjusting for demographic characteristics, neither binge drinking nor non-binge drinking were associated with HbA1c or severe hypoglycemic events relative to non-drinkers. Binge drinking was associated with higher HDL (p = 0.008), lower systolic blood pressure (p = 0.011), and a lower waist:height ratio compared to non-drinkers (p = 0.013).

Conclusions

Young adults with T1D in the SEARCH cohort reported similar alcohol use but higher rates of binge drinking compared to the general United States population and previously reported rates in adults with T1D.

Introduction

Type 1 diabetes (T1D) is a chronic disease caused by the autoimmune disruption of endogenous insulin secretion. Typically diagnosed in childhood, T1D requires careful management during adolescence and emerging young adulthood, as deterioration of metabolic control is common during this life stage. Data from the T1D Exchange demonstrates a sharp incline in HbA1c after the age of 10, peaking at the age of 19 years, and then slowly declining to reach a plateau at age 30 years [1]. Hormonal changes compounded by increasing desire for autonomy and the strict requirements of proper self-management make adolescence a uniquely difficult time to maintain good glycemic control [2]. As a result, complications and comorbidities of T1D are prevalent in adolescents and young adults diagnosed with T1D in childhood [3].

Alcohol use, is common in young adults [4]. Data suggests that adults with type 1 diabetes consume alcohol at similar rates to the general population [5]. In a recent report from the T1D Exchange study, 79% of adult participants with T1D (average age of 38 years), reported using alcohol in the past year, 63% in the past month, and 9% reported daily use [5]; 19% of participants were classified as binge drinkers in this cohort.

In the current study, we aimed to describe the drinking behaviors of young adults with T1D, and the associations of drinking, including non-binge and binge drinking, on clinical parameters such as HbA1c, severe hypoglycemia events, and cardiovascular (CV) risk markers including lipid profile, blood pressure, BMI and waist-to-height ratio (WHTR). Glycemic control and cardiovascular risk factors (lipid profile, blood pressure, BMI, WHTR) were examined as they relate to development of microvascular and macrovascular complications of T1D [3]. Severe hypoglycemia was chosen as a clinical variable given the association of alcohol use with acute and subacute hypoglycemia [6].

Section snippets

Materials and methods

SEARCH for Diabetes in Youth (SEARCH) is an ongoing multicenter population-based study of physician-diagnosed diabetes mellitus in youth < 20 years of age. Participants were identified in geographically defined populations in Colorado, Ohio, South Carolina, and Washington, among health plan enrollees in California, and Indian Health Service beneficiaries from American Indian populations. A detailed description of the SEARCH study and methods has been published [7].

Institutional review boards

Results

Of the 3863 individuals eligible for the SEARCH cohort visit, 2777 (71.9%) participated. A total of 602 participants met inclusion criteria as described above, and were included in these analyses. Of these participants, 269 (44.7%) were non-drinkers, and 167 (27.7%) were non-binge drinkers, and 166 (27.6%) were binge drinkers (Table 1). The mean number of days per month at least 1 drink was consumed was 3.29 (SD 5.2) and mean number of drinks per drinking occasion was 2.07 (SD 3.4). The study

Discussion

This report from the SEARCH study demonstrates that alcohol consumption and binge drinking are common behaviors among young adults with T1D. Rates of binge drinking were especially high in this young adult cohort compared to rates found in other adult (older) T1D cohorts; in T1D Exchange (mean age of participants was 38 years), 19% reported binge drinking [5], while we found a substantially higher rate of binge drinking (27%) with participants’ mean age of 21.4 years. This is the first study

Conclusions

This study demonstrates that young adults with T1D engage in alcohol consumption in a pattern that is similar to other individuals in their age group without diabetes, and many engage excessively. While there were no measurable adverse association between alcohol consumption in the short-term and glycemic control and CVD risk factors in the SEARCH cohort, the German/Austrian DPV registry data [23] and Norwegian mortality study [32] suggest that there are substantial acute and long-term risks of

Acknowledgements

The SEARCH for Diabetes in Youth Study is indebted to the many youth and their families, and their health care providers, whose participation made this study possible.

The authors wish to acknowledge the involvement of the Kaiser Permanente Southern California’s Clinical Research Center (funded by Kaiser Foundation Health Plan and supported in part by the Southern California Permanente Medical Group); the South Carolina Clinical & Translational Research Institute, at the Medical University of

Funding

SEARCH for Diabetes in Youth is funded by the Centers for Disease Control and Prevention (PA numbers 00097, DP-05-069, and DP-10-001) and supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Sites

Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01 DP000246, and U18DP002714), University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1), Cincinnati's Children's Hospital Medical Center (U18DP006134, U48/CCU519239, U01 DP000248, and 1U18DP002709), University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01 DP000254, and U18DP002708), Seattle Children's Hospital (U18DP006136, U58/CCU019235-4, U01 DP000244, and

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