Adults with diabetes are up to two to four times as likely to have heart disease than people who don’t have diabetes, says the American Heart Association.

Some evidence suggests that drinking moderate amounts of red wine could lessen the risk of heart disease, but other sources caution people with diabetes against drinking, period.

So what’s the deal?

More than 29 million people in the United States have diabetes. That’s nearly 1 in 10 people, according to figures from the Centers for Disease Control and Prevention (CDC).

Most cases of the disease are type 2 diabetes — a condition in which the body doesn’t make enough insulin, uses insulin incorrectly, or both. This can cause high levels of sugar in the blood.

People with type 2 diabetes must control this sugar, or blood glucose, with a combination of medications, like insulin, and lifestyle changes, such as diet and exercise. Diet is key to diabetes management.

Found in many foods such as breads, starches, fruits, and sweets, carbohydrate is the macronutrient that causes blood sugar levels to go up. Managing carbohydrate intake helps people manage their blood sugar. But contrary to popular belief, alcohol may actually cause blood sugar levels to go down instead of up.

According to the American Diabetes Association, drinking red wine — or any alcoholic beverage — can lower blood sugar for up to 24 hours. Because of this, they recommend checking your blood sugar before you drink, while you drink, and monitoring it for up to 24 hours after drinking.

The ADA also recommends avoiding drinking on an empty stomach, and only consuming alcohol along with food.

Intoxication and low blood sugar can share many of the same symptoms, so failing to check your blood glucose could cause others to assume you’re feeling the effects of an alcoholic beverage when in reality your blood sugar may be reaching dangerously low levels.

There’s another reason to be mindful of your blood sugar levels while drinking: Some alcoholic beverages, including drinks that use juice or a mixer high in sugar, can increase blood sugar.

Effects on blood sugar aside, there is some evidence that red wine might provide benefits to people with type 2 diabetes.

A recent study revealed that moderate red wine consumption (defined as one glass or 5 oz. per day in this study) can reduce the risks of heart disease in people with well-controlled type 2 diabetes.

In the study, more than 200 participants were monitored for two years. One group had a glass of red wine each night with dinner, one had white wine, and the other had mineral water. All followed a healthy Mediterranean-style diet without any calorie restrictions.

After two years, the red wine group had higher levels of high-density lipoprotein (HDL, or good cholesterol) than they did before, and lower cholesterol levels overall. They also saw benefits in glycemic control.

The researchers concluded that drinking moderate amounts of red wine in conjunction with a healthy diet can “modestly decrease” heart disease risks.

Older studies also reveal associations between moderate red wine intake and health benefits among type 2 diabetics, whether well-controlled or not. Benefits included improved post-meal blood sugar levels, better next morning fasting blood sugar levels, and improved insulin resistance.

The review also points out that it may not be the alcohol itself, but rather components of the red wine, like polyphenols (health-promoting chemicals in foods) that confer the benefits. This distinction between red wine and other alcoholic beverages was further confirmed in a 2022 study.

Red wine is loaded with antioxidants and polyphenols and is credited with numerous potential health benefits when you drink it in moderate amounts. The ADA defines moderate drinking as a maximum of one 5 oz. serving of red wine for women and two for men.

People with diabetes who choose to take advantage of these potential benefits should remember: Moderation is key, and timing of alcohol intake with food intake needs to be considered, especially for those on diabetes medicine.