Drinking wine and modern life closely together, has been integrated into modern civilization; in our country, the view of drinking wine is quite interesting, on the one hand, wine is the essence of food, is the essence of heaven and earth, on the other hand, the “cup of things” hobby but seems less honorable. After the popularity of red wine, it seems that wine is suddenly elegant, and become a symbol of taste, in addition, often drink red wine can also protect the blood vessels, but also in the prompt people, drink it, spiritual and material satisfaction. However, for diabetic patients, drinking wine will bring what kind of impact it? This is troubling a considerable number of diabetic patients; let’s take a look. Alcohol consumption and the risk of diabetes There is a “U” shaped correlation between alcohol intake and the risk of diabetes. Compared to non-drinkers, moderate drinkers had a 33%-56% lower risk of diabetes; however, heavy drinkers had a 43% increased risk of diabetes compared to moderate drinkers, which may be related to heavy drinking leading to obesity, especially abdominal fat accumulation. The American Health Professionals Study was a 12-year follow-up study of 46,892 male health care workers aged 40-75 years without a history of diabetes across the United States. A total of 1,571 study participants developed diabetes over the course of the study. Compared to non-drinkers, those who consumed 15-29 g/day of alcohol had a 36% lower risk of developing diabetes. There was also a negative association between the frequency of alcohol intake and the risk of diabetes, with alcohol intake at least 5 days per week providing the greatest protection. Different alcoholic beverages such as beer and white wine had a similar, independent negative association. The researchers thus concluded that high frequency of alcohol consumption had the greatest protective effect on the development of type 2 diabetes, even at low daily alcohol intake, and that this effect was independent of the type of alcoholic beverage. The exact mechanism for the beneficial effects of moderate alcohol consumption on glycemic control is unclear. Possible reasons include inhibition of growth factors, increased levels of insulin-binding proteins, changes in hepatic glucose metabolism including reduced gluconeogenesis, downregulation of insulin counter-regulatory hormones, increased high-density lipoprotein (HDL), decreased C-reactive protein levels, and increased circulating levels of leptin. Alcohol consumption and hypoglycemia Because alcohol inhibits hepatic gluconeogenesis and hepatic glycogenolysis, fasting alcohol consumption can lead to hypoglycemia, especially in the presence of inadequate hepatic glycogen reserves or concomitant oral insulinotropic drugs. Among patients with type 1 diabetes, alcohol is a clear risk factor for the development of hypoglycemia. In a trial of alcohol consumption in six patients with type 1 diabetes, Benjamin et al. showed that evening alcohol intake (0.75 g of alcohol per kg of body weight at 9:00 P.M.) resulted in a significant decrease in fasting and post-breakfast glucose the following day and increased the risk of post-breakfast hypoglycemia. This trial also found that growth hormone secretion was significantly reduced from midnight to 4:00 a.m. after evening alcohol intake, and it is believed that the occurrence of hypoglycemia is partly due to the inhibition of hepatic glucose output by alcohol, and may additionally be related to reduced growth hormone secretion and increased insulin sensitivity of peripheral tissues. Given that alcohol increases the risk of hypoglycemia and its central inhibition can also mask the symptoms of hypoglycemia and impair the body’s negative regulatory response to hypoglycemia, the British and American Diabetes Association guidelines recommend that diabetic patients should not consume more than 2 units of pure alcohol per session, and for patients receiving insulin therapy, it is emphasized that carbohydrates are essential in the diet and alcohol intake should be chosen near meals or at the same time as meals. Effects of alcohol consumption on cardiovascular complications of diabetes For the majority of diabetic patients, coronary atherosclerotic heart disease (CHD) is the leading cause of death. A recent cohort study of 14,734 U.S. adults with diabetes found that coronary heart disease contributed to 69% of all deaths. The risk of developing coronary heart disease is much higher in diabetics than in the non-diabetic population, and clinically significant coronary heart disease also occurs significantly earlier in diabetics than in the general population. The effect of alcohol consumption on cardiovascular disease is complex, and although heavy alcohol intake increases overall mortality and death from cardiovascular disease, moderate alcohol consumption shows a protective effect on coronary heart disease compared with non-drinkers, showing a “U” shaped association, i.e., the lowest risk for moderate alcohol consumption and an increased risk for non-drinkers and heavy drinkers. Solomon et al. observed 295 coronary events in 5103 subjects with diabetes diagnosed after 30 years of age and no history of coronary heart disease in the American Nurses’ Health Study during follow-up from 1980 to 1994. The relative risk of fatal or nonfatal coronary heart disease was 0.74 for diabetics consuming 0.1-4.9 g of alcohol per day compared with nondrinkers and 0.48 for those consuming 5 g/day. Moderate alcohol consumption had the same effect of reducing the risk of death from coronary heart disease in the diabetic population. Many clinical observations have further explored the possible mechanisms by which moderate alcohol consumption reduces the risk of cardiovascular complications in diabetes. Alcohol consumption and HDL Clinical observations and experimental studies suggest that alcohol can elevate serum HDL and suggest that approximately 50% of the effect of moderate alcohol consumption in reducing the risk of coronary heart disease can be explained by changes in HDL. a case-control study conducted by Gaziano et al. in 340 patients under 76 years of age with heart attack in the Boston area, USA, showed that total HDL and its HDL2, HDL3 fraction levels were significantly correlated with alcohol consumption, and in the moderate drinking group, elevated levels of HDL and its fractions significantly reduced the risk of coronary heart disease, whereas no correlation was seen between total cholesterol, LDL, and triacylglycerol levels and alcohol consumption, so it was concluded that alcohol consumption was not involved in this role of reducing the risk of coronary heart disease. Alcohol consumption and serum inflammatory factors Inflammation is widely accepted as a central mechanism in the pathogenesis of coronary heart disease, and elevated levels of serum inflammatory factors and dysfunction of the vascular endothelium in diabetic patients are key factors in their development of cardiovascular complications. Michelle et al. studied the drinking status and serum C-reactive protein (CRP) levels in 1732 men and 1101 women participating in the pravastatin trial and found that CRP levels were lower in the moderate drinking group than in the non-drinking or occasional drinking group, and that this effect was independent of changes in lipid levels associated with alcohol consumption. shai et al. selected 726 individuals in the US Health Professionals Study who provided Shai et al. studied the relationship between alcohol intake and inflammation in 726 subjects with confirmed type 2 diabetes in the American Health Professionals Study and found that moderate alcohol consumption reduced serum tumor necrosis factor-α (TNF-α), fibrinogen and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels and increased lipocalin and HDL levels in patients with type 2 diabetes. No statistically significant differences were seen in the reduction of CRP levels in the study, so it is thought that the effect of alcohol consumption on CRP in the diabetic population may be less pronounced than in the non-diabetic population. Alcohol consumption and the coagulation and fibrinolytic system Alterations in the activity of the coagulation and fibrinolytic systems of the body are involved in the pathogenesis of coronary heart disease. a crossover trial of 3223 adults with no previous history of cardiovascular disease who participated in the Framingham Offspring Study by Kenneth et al. showed that light to moderate alcohol consumption reduced blood levels of fibrinogen, vW factor, factor VII levels and plasma viscosity with little change in fibrinolytic activity; heavy alcohol consumption was associated with increased blood levels of prothrombin activator inhibitor-1 (PAI-1) and tissue-type fibrinogen activator (TPA) antigen compared with moderate alcohol consumption, thus suggesting that the interrelationship between coagulation and fibrinolytic system activity is involved in the effect of alcohol consumption on the risk of coronary heart disease. Alcohol consumption and insulin sensitivity There are varying degrees of insulin resistance in patients with type 2 diabetes, and insulin resistance is one of the risk factors for atherosclerosis. In a randomized crossover trial of 23 healthy middle-aged men, Sierksma et al. found that alcohol consumption (40 g alcohol/day for 17 days) increased insulin sensitivity in a subgroup with insulin resistance, and that this effect was mediated by increased plasma lipocalin levels due to alcohol consumption. As the incidence of diabetes increases each year, diabetes and its complications are gaining more and more attention. Current data suggest that moderate alcohol consumption may reduce the risk of developing diabetes, improve glycemic control, and reduce the incidence of cardiovascular complications of diabetes. The possible mechanisms underlying these effects are not well understood and require further exploration and research. In addition, although many trials have shown no significant difference in the cardiovascular protective effects of alcohol consumption in diabetic and non-diabetic populations, it has been suggested that alcohol intake reduces the degree of atherosclerosis by measuring carotid intima-media thickness in a normal glucose tolerance state, and this effect is present in different subgroups of alcohol intake; in an impaired glucose tolerance (non-diabetic) In the impaired glucose tolerance (non-diabetic) state, a “J” correlation was observed between alcohol intake and atherosclerosis, whereas in the diabetic state, even moderate, moderate alcohol intake was harmful. Moreover, as part of lifestyle, different drinking patterns may represent different lifestyle tendencies, which may bias clinical observations. Therefore, more rational, standardized and scientific experimental studies still need to be designed to further clarify the understanding. Second, the effect of alcohol consumption on other complications of diabetes such as diabetic nephropathy is inconclusive. Finally, from a public health perspective, considering the medical and social problems associated with alcohol consumption and the lack of sufficient evidence to recommend alcohol consumption to reduce disease risk, clinicians must make the decision to recommend moderate alcohol consumption with full consideration of the pros and cons and individual differences, and further research is warranted on the Chinese style of alcohol consumption.