Purpose: The purpose of the proposed study is to; 1) determine the association between levels of alcohol consumption and poor glycemic control in type II diabetic patients, 2) examine the relationship between level of alcohol consumption and diabetic therapy compliance, 3) determine the association between poort glycemic control and alcohol consumption and its relationship to alcohol dependence, and 4) determine if a Twelve Step Treatment intervention can improve glycemic control and compliance in alcohol dependent diabetics. Design: The study will be conducted in the primary ambulatory clinic for a University affiliated family practice residency training program. Consecutive diabetic patients who enter the health center will be screened for participation following their routine visit with their primary care physician. After informed consent is obtained, each qualified participating subject will be interviewed to determine their level of alcohol consumption over the last 3 months. In addition, moderate and heavy drinkers will be evaluated to determine their likelihood of harmful alcohol consumptionusing the Alcohol Use Disorders Identification Test (AUDIT)1. Patients will also be queried regarding their level of compliance with prescribed therapies (pharmacologic and non-pharmacologic). After the interview, their blood will be sampled and their hemoglobin A1c (HbA1c) and C- peptide levels determine. HbA1c levels will beused to assess their glycemic control over the previous 3 months. C-peptide will be used initially to confirm their status as type II diabetics. All diabetics that are identified as having a strong likelihood of harmful alcohol consumption by AUDIT will receive a standard diagnostic interview DSM-IV. Those who meet the criteria for alcohol dependence will be offered a twelve step treatment intervention. These subjects will be have their sobriety, glycemic control and compliance measured at 0, 3, 6, 9, and 12 months following the initiation of treatment. Results: The degree of linear correlation between alcohol consumption(ounces/day) and HbA1c will be assessed and reported as a correlation coefficient. The mean HbA1c levels for alcoholic versus non-alcoholic diabetics will also be compared. Compliance scores willb e compared for the following groups: moderate-heavy versus non-drinking diabetics, addicted versus non-addicted diabetics. Baseline HbA1c and compliance scores will be compared with those at 3 month intervals after treatment.
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