Spangler J G, Konen J C, McGann K P
Department of Family and Community Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27517-1084.
J Fam Pract. 1993 Oct;37(4):370-5.
Alcohol abuse among patients with diabetes mellitus is dangerous and complicates therapy, but its prevalence and the factors that predict it are unknown. This study examined the prevalence of problem drinking among a large number of primary care diabetic patients, exploring its relation to age, race, sex, psychological factors, and other health behaviors.
Volunteers with insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were surveyed at three primary care practice sites. Patients completed a health risk appraisal designed to elicit alcohol use and other health practices, and two psychometric instruments: the Brief Encounter Psychosocial Instrument and the Affect Balance Scale. Fasting blood glucose and hemoglobin A1C levels were also determined.
Of 395 diabetic patients, 32 (8.1%) had a drinking problem as defined by answering yes to the question "Have you ever had a drinking problem?" or reporting their last drink to be within 24 hours, or both. Patients with a drinking problem coped less well with psychological stress and had a more highly negative affect than those without a drinking problem. Depression, black race, and male sex were significantly associated with problem drinking (odds ratios = 8.42, 2.70, and 3.80, respectively). Problem drinking did not predict glycemic control but was associated with smoking and less frequent glucose monitoring.
The prevalence of problem drinking among patients with diabetes mellitus appears lower than among other medical outpatient populations and is in keeping with the prevalence found in community surveys. While the lack of association between problem drinking and glycemic control in diabetic patients may be surprising, these data help define the characteristics of this subgroup of diabetic patients and highlight the need for family physicians to intensify alcohol screening efforts in this population.
糖尿病患者酗酒危险且会使治疗复杂化，但其患病率及预测因素尚不清楚。本研究调查了大量初级保健糖尿病患者中存在饮酒问题的情况，探讨其与年龄、种族、性别、心理因素及其他健康行为的关系。
在三个初级保健医疗机构对胰岛素依赖型糖尿病和非胰岛素依赖型糖尿病志愿者进行调查。患者完成一项旨在获取饮酒及其他健康行为信息的健康风险评估，以及两项心理测量工具：简易遭遇心理社会工具和情感平衡量表。还测定了空腹血糖和糖化血红蛋白水平。
在395名糖尿病患者中，32名（8.1%）存在饮酒问题，其定义为对“你是否曾有饮酒问题？”这一问题回答“是”，或报告其最后一次饮酒在24小时内，或两者皆有。有饮酒问题的患者应对心理压力的能力较差，且比无饮酒问题的患者有更高度的负面情绪。抑郁、黑人种族和男性性别与饮酒问题显著相关（优势比分别为8.42、2.70和3.80）。饮酒问题不能预测血糖控制，但与吸烟及较少进行血糖监测有关联。
糖尿病患者中存在饮酒问题的患病率似乎低于其他门诊患者群体，与社区调查中发现的患病率相符。虽然糖尿病患者中饮酒问题与血糖控制缺乏关联可能令人惊讶，但这些数据有助于明确该糖尿病患者亚组的特征，并凸显家庭医生加强对该人群酒精筛查工作的必要性。
