Low-moderate alcohol use effects on glycemic control of patients presenting in the ED

The prevalence of Type 2 Diabetes Mellitus (DM2) is rising, affecting 462 million globally, including 21 million in the U.S. Emergency Department (ED) visits by adults with diabetes in the U.S. increased by 54% from 2012 to 2021 and represent a significant portion of global ED visits. Concurrently, 62% of U.S. adults report lifetime alcohol consumption. This study aimed to correlate AUDIT-C scores to changes in glucose and HbA1c levels in patients with DM2. Previous research has produced mixed results on whether light-to-moderate alcohol use improves or worsens glycemic control. Using a large urban ED dataset, this study seeks to better define this relationship and guide interventions for alcohol use in patients with DM2.

Data from Long Island Jewish ED (January 2022-October 2023) was analyzed. Patients were included based on an HbA1c ≥ 6.5 or a secondary discharge diagnosis of DM2. AUDIT-C scores were treated as a categorical variable, as no dose-dependent relationship was observed. Statistical analysis was conducted using SPSS 26.

Non-zero AUDIT-C scores were significantly associated with increases in POCT-Blood Glucose, estimated average glucose, and HbA1c. A linear regression model showed an R-value of 0.047 (p < 0.001) for POCT-Blood Glucose in patients with HbA1c ≥ 6.5. Patients with an AUDIT-C score ≥ 1 had higher mean POCT-Blood Glucose (249.72 vs. 226.48, t = 4.240, p < 0.001). Estimated average glucose showed an R-value of 0.045 (p < 0.001), with a mean difference of 11.872 (t = 4.155, p < 0.001). For HbA1c, the R-value was 0.036 (p = 0.004), with higher levels in patients with AUDIT-C ≥ 1 (8.265 vs. 7.904, t = 2.844, p = 0.005). The effects were more pronounced in African-American and Asian-American populations.

Alcohol use, even at moderate levels (AUDIT-C = 1), was associated with higher glucose and HbA1c levels in patients with DM2, particularly among African-American and Asian-American populations. These findings suggest the need for substance use interventions at lower AUDIT-C thresholds and further considerations to mitigate future risk in this population.