1. Alcohol Consumption and Diabetes Preventive Practices: Preliminary Findings from the U.S.-Mexico Border Patrice A.C. Vaeth, Dr.P.H. Raul Caetano, M.D., Ph.D. University of Texas, School of Public Health, Dallas Regional Campus

2. Alcohol Consumption and Diabetes Preventive Practices  Alcohol consumption, even at low levels, is associated with poor adherence to self-management practices.* * Ahmed et al. Diabetic Medicine 2006;23:795-802. Chew et al. Family Medicine 2005;37:589-594. Johnson et al. Archives of Family Medicine 2000;9:964-970.

3. Adjusted OR (95% CI) of Nonadherence to Diabetes Preventive Practices by Drinking Category (2001 BRFSS ) Moderate DrinkerHeavy Drinker (n=2,859)(n=198) No daily glucose self-monitoring1.3 (1.1-1.5)1.8 (1.1-2.9) No annual HbA1c monitoring1.1 (0.8-1.4)1.3 (0.6-2.7) No professional foot exam1.1 (0.9-1.3)1.4 (0.8-2.3) No annual dilated eye exam1.2 (1.0-1.4)2.2 (1.4-3.5) No formal diabetes education1.0 (0.9-1.2)1.3 (0.8-2.0) No annual provider visit1.8 (1.4-2.4)1.7 (0.9-3.2) Controlling for age, gender, race, education, marital status, income, health care coverage, duration of diabetes, health status, and insulin use. L.D. Chew et al. Family Medicine 2005;37:589-594

4. Adherence to Diabetes Self-Care Behaviors by Past Year Average Daily Alcohol Consumption (Kaiser Permanente Data, N=65,996) Exercise Diet Medication Self- Monitoring No HbA1c Smoking NS P >.10, † P=.10, * P=.05, ** P=.01, *** P <.001. A. T. Ahmed et al. Diabetic Medicine 2006;23:795-802.

5. Alcohol, Ethnicity, and Diabetes  How does the association between drinking and diabetes self-care practices vary by ethnicity and culture?  Why is this important?  Diabetes is common and disproportionately affects certain ethnic groups.  Drinking is common and drinking practices differ in relation to ethnicity and culture.

6. Age-Adjusted Prevalence of Diagnosed Diabetes: Adult U.S. General Population and by Ethnic Group, 2002-2007 % Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

7. Age-Adjusted Prevalence of Diagnosed Diabetes: Adult U.S. General Hispanic Population and by Hispanic National Group, 2002-2007 % Centers for Disease Control and Prevention. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

8. Diabetes in U.S.-Mexico Border Regions  PAHO 2002, U.S.-Mexico Border Diabetes Prevention and Control Project.  U.S. side: 15.7%  11.4% aware  4.3% unaware  Mexican side: 15.1%  8.5% aware  6.6% unaware

9. U.S.-Mexico Border Study  Funded by NIAAA.  Multistage cluster sample.  Data collected in U.S.-Mexico border areas of California, Arizona, New Mexico, and Texas between March 2009 and June 2010.  Face-to-face interviews conducted in respondents’ homes in either Spanish or English.  N=1307.  Response rate of 67%.  Prevalence of self-reported diabetes: 14.2%

10. Selected Characteristics of those with Diabetes in the Border Sample (N=184) DiabeticsNon-Diabetics  Mean age58 years41 years  Female gender55%56%  Foreign birth(Mexico)63%51%  < High school education54%36%  Annual income < &10,000.29%27%  No medical insurance31%49%  Obese54%39%

11. Number of Drinks Consumed per Week and the Proportion who Binged at Least Once per Year among Men and Women Residing in U.S.-Mexico Border Regions (N=1307). # of drinks/ week Binge Drinking Men: ≥ 5 drinks within a 2 hour period. Women: ≥ 4 drinks within a 2 hour period. %

12. The Number of Drinks Consumed Per Week among Non-Diabetic and Diabetic Male and Female Drinkers (N=1307) # of Drinks/ week P =.04 P <.001

13. Proportion of Abstainers, Non-Binge Drinkers, and Binge* Drinkers by Diabetic Status (N=1307) % Binge Drinking Men: ≥ 5 drinks within a 2 hour period. Women: ≥ 4 drinks within a 2 hour period. NS% P <.001 Men Women

14. Non-adherence to Diabetes Preventive Practices on the U.S.-Mexico Border by Drinking Status (N=184) % * P >.05 ** P <.05 *** P <.001

15. Adjusted OR (95% CI) of Non-adherence to Diabetes Preventive Practices by Drinking Category (N=184) Non-BingeBingeDrinker No annual provider visit0.49 (0.09-2.64)6.95 (1.01-48.19) No annual HbA1c monitoring0.28 (0.03-3.08)1.49 (0.04-59.62) No annual dilated eye exam2.97 (1.22-7.22)4.07 (0.72-23.11) No professional foot exam0.45 (0.12-1.69)0.23 (0.04-1.39) No glucose self-monitoring2.89 (0.78-10.72)4.57 (1.53-13.65) Controlling for age, gender, place of birth, education, income, and health care coverage.

16. Lack of Screening for Diabetes among Non-Diabetics in Relation to Drinking Status (N=1108) % P <.001 NS

17. Adjusted OR (95% CI) for No Screening for Diabetes in the Previous Three Years among Non-Diabetics by Drinking Category (N=1108) Risk Factors: Drinking Pattern (ref: non-binge drinking) Abstention1.59 (1.11-2.29) Binge drinking1.50 (1.01-2.26) Age (ref: 60+ years) 20-49 years2.79 (1.84-4.23) No medical insurance1.34 (1.01-1.80) Protective Factors: Female gender0.90 (0.49-0.90) Controlling for place of birth, education, and income.

18. Conclusions  Alcohol consumption appears to influence some, but not all preventive behaviors.  A pattern of heavy alcohol consumption may be indicative of an overall lifestyle that is not conducive to positive health behaviors.  Health providers should routinely assess the drinking patterns of their patients and address its significance as a risk factor for poor self-care practices and poor glucose control.

19. Acknowledgement This work was supported by a grant (R01-5R01AA16827-3) from the National Institute on Alcohol Abuse and Alcoholism to the University of Texas School of Public Health.