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appears to optimise the ways in which our body uses glucose, such as
enhancing the uptake of this sugar by muscle cells.

The effect of alcohol on the risk of developing T2DM appears to be
less clear cut. A meta-analysis of 15 prospective cohort studies demon-
strates a U-shaped relationship between alcohol consumption and the
risk of developing T2DM. In those people who consume a moderate
45
amount of alcohol (6–48 g/day) there is highly significant, 30% reduced
risk of T2DM, but no risk reduction is observed in heavy consumers (≥48
g/day) or those who abstain from alcohol.
45

Exactly why there should be such a relationship between alcohol
consumption and risk of T2DM is not fully understood. Moderate al-
cohol consumption is known to increase HDL cholesterol concentra-
tion, whereas, higher consumption is known to be associated with in-
46
creased body weight, triglyceride concentration and blood pressure
increase. 47-50 Alcohol also has anti-inflammatory effects and these may
provide some degree of protection from the inflammatory mechanisms
involved in the development of T2DM. 51 52 Enhanced insulin sensitivity
with lower plasma insulin concentrations is another potential mecha-
nism that explains this relationship. 48

Figure 9. Age-adjusted incidence rates of T2D with exercise frequency. 44
Smoking is also known to increase the risk of developing T2DM. Tobac-
co, or at least some of the biologically active compounds in commer-
cial tobacco, can result in high blood sugar levels and insulin insensitiv-
ity. 53 54 A study in US male physicians showed that in past smokers and
those who smoked <20 or ≥20 cigarettes per day the relative risk of
developing T2DM was 1.2 (95% CI: 1.0–1.4), 1.4 (95% CI: 1.0–2.0) and 2.1
(95% CI: 1.7–2.6), respectively. 55
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