On 2015 Oct 17, David Keller commented:

Wine should be diluted to reduce epithelial carcinogenic effects in the upper aerodigestive tract

Epidemiologic evidence suggests that people with diabetes are at significantly higher risk for many forms of cancer [1]. It has also been observed that cancer patients with pre-existing diabetes experience higher mortality than cancer patients without diabetes [2]. The randomized controlled trial by Gepner and colleagues confirmed prior observations that moderate ethanol consumption is associated with improved cardiometabolic risk in diabetics and in other groups [3].

A large observational study reported data on cancer and other harms among drinkers whose usual alcoholic beverage was wine, beer or spirits [4]. A dose-response relationship was identified between the concentration of ethanol in the beverage of choice, and the incidence of cancers among those who consumed it [5]. The risk of cancer for drinkers of beer (which contains about 5% ethanol), wine (12% ethanol) and distilled spirits (40% ethanol) were each divided by the cancer risk for teetotalers to yield respective cancer harm ratios (HRs) of 1.2, 1.38 and 1.69; note the dose-response relationship between the ethanol concentration in a beverage, and cancer rates for those who drink that beverage. The cancer HR for beer drinkers was not statistically significantly elevated above that for teetotalers, but its trend is consistent with the proposed dose-response relationship.

Given the elevated risk of cancer in diabetics, and a risk of cancer in drinkers of alcoholic beverages which increases monotonically with the concentration of ethanol in the beverage, it seems prudent for diabetics who consume ethanol to dilute their beverage of choice to a concentration of 5% or less. Wine can be diluted to 4% ethanol by combining one part wine with two parts water or juice.

References:

1: Giovannucci E, Harlan DM, Archer MC, Bergenstal RM, Gapstur SM, Habel LA, Pollak M, Regensteiner JG, Yee D. Diabetes and cancer: a consensus report. Diabetes Care. 2010 Jul;33(7):1674-85. doi: 10.2337/dc10-0666. PubMed PMID: 20587728; PubMed Central PMCID: PMC2890380.

2: Ranc K, Jørgensen ME, Friis S, Carstensen B. Mortality after cancer among patients with diabetes mellitus: effect of diabetes duration and treatment. Diabetologia. 2014 May;57(5):927-34. doi: 10.1007/s00125-014-3186-z. Epub 2014 Mar 15. PubMed PMID: 24633676.

3: Gepner Y, Golan R, Harman-Boehm I, Henkin Y, Schwarzfuchs D, Shelef I, et al. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes: A 2-Year Randomized, Controlled Trial. Ann Intern Med. [Epub ahead of print 13 October 2015] doi:10.7326/M14-1650

4: Smyth A, Teo KK, and the PURE Investigators. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. Lancet. 2015 Sep 17. doi:10.1016/S0140-6736(15)00235-4. PubMed PMID: 26386538.

5: Keller DL. Dose-response relationship observed between concentration of ingested alcohol and cancer rate. Comment on PMID 26386538. In: PubMed Commons [Internet]. National Library of Medicine; 2015 Sept 26 [cited 2015 Oct 12]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26386538#cm26386538_11980

The above comment is also posted on the following Annals of Internal Medicine web page:

http://annals.org/article.aspx?articleid=2456121

On 2015 Oct 17, David Keller commented:

Wine should be diluted to reduce epithelial carcinogenic effects in the upper aerodigestive tract

Epidemiologic evidence suggests that people with diabetes are at significantly higher risk for many forms of cancer [1]. It has also been observed that cancer patients with pre-existing diabetes experience higher mortality than cancer patients without diabetes [2]. The randomized controlled trial by Gepner and colleagues confirmed prior observations that moderate ethanol consumption is associated with improved cardiometabolic risk in diabetics and in other groups [3].

A large observational study reported data on cancer and other harms among drinkers whose usual alcoholic beverage was wine, beer or spirits [4]. A dose-response relationship was identified between the concentration of ethanol in the beverage of choice, and the incidence of cancers among those who consumed it [5]. The risk of cancer for drinkers of beer (which contains about 5% ethanol), wine (12% ethanol) and distilled spirits (40% ethanol) were each divided by the cancer risk for teetotalers to yield respective cancer harm ratios (HRs) of 1.2, 1.38 and 1.69; note the dose-response relationship between the ethanol concentration in a beverage, and cancer rates for those who drink that beverage. The cancer HR for beer drinkers was not statistically significantly elevated above that for teetotalers, but its trend is consistent with the proposed dose-response relationship.

Given the elevated risk of cancer in diabetics, and a risk of cancer in drinkers of alcoholic beverages which increases monotonically with the concentration of ethanol in the beverage, it seems prudent for diabetics who consume ethanol to dilute their beverage of choice to a concentration of 5% or less. Wine can be diluted to 4% ethanol by combining one part wine with two parts water or juice.

References:

1: Giovannucci E, Harlan DM, Archer MC, Bergenstal RM, Gapstur SM, Habel LA, Pollak M, Regensteiner JG, Yee D. Diabetes and cancer: a consensus report. Diabetes Care. 2010 Jul;33(7):1674-85. doi: 10.2337/dc10-0666. PubMed PMID: 20587728; PubMed Central PMCID: PMC2890380.

2: Ranc K, Jørgensen ME, Friis S, Carstensen B. Mortality after cancer among patients with diabetes mellitus: effect of diabetes duration and treatment. Diabetologia. 2014 May;57(5):927-34. doi: 10.1007/s00125-014-3186-z. Epub 2014 Mar 15. PubMed PMID: 24633676.

3: Gepner Y, Golan R, Harman-Boehm I, Henkin Y, Schwarzfuchs D, Shelef I, et al. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes: A 2-Year Randomized, Controlled Trial. Ann Intern Med. [Epub ahead of print 13 October 2015] doi:10.7326/M14-1650

4: Smyth A, Teo KK, and the PURE Investigators. Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study. Lancet. 2015 Sep 17. doi:10.1016/S0140-6736(15)00235-4. PubMed PMID: 26386538.

5: Keller DL. Dose-response relationship observed between concentration of ingested alcohol and cancer rate. Comment on PMID 26386538. In: PubMed Commons [Internet]. National Library of Medicine; 2015 Sept 26 [cited 2015 Oct 12]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26386538#cm26386538_11980

The above comment is also posted on the following Annals of Internal Medicine web page:

http://annals.org/article.aspx?articleid=2456121