Reducing harm caused by alcohol

News Alcohol and diabetes

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Alcohol and diabetes: a guest blog post from Diabetes Scotland

The relationship between alcohol consumption and diabetes is complex and our understanding of it is still evolving. We do know that people who drink heavily are at higher risk of developing type 2 diabetes than people who drink moderately,[1],[2],[3],[4] partly (but not only) due to the contribution alcohol can make to overweight and obesity.[5] So at Diabetes Scotland we’re supporting Alcohol Focus Scotland’s mission to reduce alcohol-related harms, understanding that type 2 diabetes, alcohol problems and obesity are all part of a wider public health challenge which can’t be tackled in isolation.

Type 2 diabetes is a serious condition where the insulin your pancreas makes doesn’t work properly, or you don’t make enough insulin, leading to a build-up of glucose (sugar) in your blood.[6] Managing type 2 diabetes can be a huge mental burden[7] as it usually involves a combination of diet, exercise, tablets, and sometimes insulin injections. Diabetes also carries a risk of long-term complications including stroke, sight loss and kidney damage.[8] Just like developing problems with alcohol or living with obesity, type 2 diabetes is not inevitable. It is influenced by environmental and genetic factors and can be preventable.[9] But this also means that it is often highly stigmatised, becoming a source of shame and guilt for some people.[10]

This isn’t right – no one should be made to feel like issues with their health are their fault. Rather, we need to recognise that these are entrenched social issues requiring population-wide action. The numbers make this clear: with around 300,000 people living with type 2 diabetes in Scotland,[11] a further 620,000 at risk of type 2 diabetes,[12] almost a quarter of the population drinking hazardous or harmful amounts of alcohol each week[13] and two thirds living with overweight or obesity,[14] we know that this isn’t simply a question of individual choice.

A large part of the problem is poverty and inequality. We all know that we’re still deep in a cost-of-living crisis, with inequalities between the richest and poorest people remaining far too wide.[15] It’s no coincidence that type 2 diabetes and alcohol-related harms are both more prevalent in the most deprived areas of Scotland than in the least deprived areas,9,[16],[17] while there’s often a greater density of alcohol and fast food retailers in more deprived areas,[18] and healthy food is on average around three times more expensive than unhealthy food.[19] Minimum Unit Pricing has helped by removing the cheapest alcohol from shelves, saving around 150 lives per year since its introduction,[20] but the 50p/unit minimum hasn’t changed since 2012 and we agree with Alcohol Focus Scotland’s call for a new 65p minimum.

The food and drink environment is currently skewed towards health-harming products. That’s why we support measures to tackle the problem at its source. This March, we responded to a Scottish Government consultation[21] voicing our support for a comprehensive ban on alcohol advertising and promotions, as recommended by the Alcohol Marketing Expert Network[22] and the World Health Organisation.[23] Now, with the new First Minister Humza Yousaf MSP in post, we’re calling on him to take forward these restrictions to the fullest extent possible.

As the former Cabinet Secretary for Health and Social Care, he will recognise the importance of tackling both alcohol-related harms and the rising rates of type 2 diabetes in Scotland. We would urge him to take every opportunity he has in his new role to support whole system approaches to these issues, considering social and commercial factors as a crucial part of the equation. If we’re serious about protecting Scotland’s health, we need to take action where it counts.

 8 June 2023

The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Focus Scotland.

[1] Howard, A. A., Arnsten, J. H., Gourevitch, M. N. (2004) Effect of Alcohol Consumption on Diabetes Mellitus: a Systematic Review. Annals of Internal Medicine, 140(3), 211–19. https://doi.org/10.7326/0003-4819-140-6-200403160-00011.

[2] Lai, Y.-J., Hu, H.-Y., Lee, Y.-L., Ko, M.-C., Ku, P.-W., Yen, Y.-F., Chu, D. (2019) Frequency of alcohol consumption and risk of type 2 diabetes mellitus: A nationwide cohort study. Clinical Nutrition, 38(3), 1368–1372. https://doi.org/10.1016/j.clnu.2018.06.930

[3] Knott, C., Bell, S., Britton, A. (2015) Alcohol Consumption and the Risk of Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of More Than 1.9 Million Individuals From 38 Observational Studies. Diabetes Care, 38 (9), 1804–1812. https://doi.org/10.2337/dc15-0710.

[4] Twenefour, D., Dyson, P. (2018) Evidence-based nutrition guidelines for the prevention and management of diabetes. Diabetes UK.

[5] Golzarand, M., Salari-Moghaddam, A., Mirmiran, P. (2022) Association between alcohol intake and overweight and obesity: a systematic review and dose-response meta-analysis of 127 observational studies. Critical Reviews in Food Science and Nutrition, 62(29), 8078-8098. https://doi.org/10.1080/10408398.2021.1925221.

[7] Diabetes UK (2023) Emotional and mental health support is too often missing. https://www.diabetes.org.uk/get_involved/campaigning/emotional-wellbeing

[8] Diabetes UK (2023) Complications of Diabetes. https://www.diabetes.org.uk/guide-to-diabetes/complications

[9] Diabetes UK (2022) Prevention of Type 2 diabetes & Gestational diabetes by addressing the root causes of ill health. Position statement: October 2022. https://www.diabetes.org.uk/professionals/position-statements-reports/type-2-diabetes-prevention-early-identification/prevention-of-type-2-diabetes-whole-society-interventions-to-address-root-causes-ill-health

[10] Diabetes UK (2023) Advancing research into diabetes-related stigma. https://www.diabetes.org.uk/research/for-researchers/apply-for-a-grant/diabetes-stigma-research

[13] Public Health Scotland (2021) Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS). https://www.publichealthscotland.scot/media/8090/mesas-monitoring-report-2021.pdf.

[14] Hinchliffe, S., Wilson, V. (eds) (2021) The Scottish Health Survey 2021 - volume 1: main report. https://www.gov.scot/publications/scottish-health-survey-2021-volume-1-main-report/documents/.

[15] Finch, D., Wilson, H., Bibby, J. (2023) Leave no one behind: The state of health and health inequalities in Scotland. The Health Foundation. https://doi.org/10.37829/HF-2023-HL01.

[18] Macdonald, L., Olsen, J. R., Shortt, N. K., Ellaway, A. (2018) Do ‘environmental bads’ such as alcohol, fast food, tobacco, and gambling outlets cluster and co-located in more deprived areas in Glasgow City, Scotland? Health & Place, 51, 224-231. https://doi.org/10.1016/j.healthplace.2018.04.008.

[19] The Food Foundation (2022) The Broken Plate 2022: The State of the Nation’s Food System. https://foodfoundation.org.uk/publication/broken-plate-2022.

[20] Wyper, G. M. A., Mackay, D. F., Fraser, C., Lewsey, J., Robinson, M., Beeston, C., Giles, L. (2023) Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study. The Lancet. https://doi.org/10.1016/S0140-6736(23)00497-X.

[21] Scottish Government (2023) Alcohol advertising and promotion. https://consult.gov.scot/alcohol-policy/alcohol-advertising-and-promotion/.

[22] Alcohol Focus Scotland (2022) Realising our rights: How to protect people from alcohol marketing. A report by the Alcohol Marketing Expert Network. /media/440172/alcoholmarketingreport2806.pdf.

[23] World Health Organization (2019) The SAFER technical package: five areas of intervention at national and subnational levels. https://www.who.int/publications/i/item/9789241516419.