By Nicole Bereolos, PhD, MPH, CPH, MSCP, CDCES, FADCES 

People with diabetes manage more in their day-to-day lives than just their glucose levels—they’re navigating everyday stress as well. Some may struggle with complex mental health issues like disordered eating, substance abuse, or alcohol use disorder—all of which can impact overall health and diabetes management. For example, people with both type 2 diabetes and alcohol use disorder may be twice as likely to develop diabetes-related complications (DOI: 10.3399/BJGPO.2024.0133). 

We as diabetes care and education specialists can play a critical role in helping our clients explore and reduce harmful alcohol use. Having person-centered, honest and supportive discussions about alcohol use can be key to reducing the negative health impacts of alcohol use. Below are a few tips that can help get a conversation started. 

1. Start by asking how much — and be specific. 
   Most people underestimate their alcohol intake. Ask how much alcohol your client is consuming in a curious, yet nonjudgmental way. Get the full picture before offering specific advice or support. 

2. Withold judgement. Refrain from labeling your client’s alcohol use as a “problem.” Watch their physical/verbal/emotional cues instead and let them lead you to an aspect of their lives they identify alcohol use may be impacting. 

3. Use humor to break the ice. Try something like: “Is this one glass?” while holding up your 1L water bottle. If they laugh or express concern, that’s your moment to ask, “Is this something you want to change?” Sometimes humor can help to build trust. 

4. Set realistic goals — together. If a client is drinking seven alcoholic drinks a day, it may be difficult to cut that down dramatically all at once. Suggest that they try to aim for five drinks for a certain period of time and then assess how successful that trial was. It’s always valuable to ask: “What would help you be successful?” 

5. Follow up with openness, not perfection. At any follow up meetings where significant lifestyle changes are being made, make it a habit to ask your client this simple question: “How was it?” Then keep the momentum going by asking “How can we tweak your plan?” Support small changes, not just total overhauls. 

6. Be their biggest cheerleader. Positive reinforcement drives sustainable change. Make sure to recognize any wins—not matter how big or small. 

7. Normalize setbacks — and plan for them. Slip-ups happen. Help your clients recognize and confront these challenges. Ask “What will help you get back on track if that happens?” This will help you create a plan to get back on a good track. 

Practicing and encouraging harm reduction involves empathy, trust and honesty. The more real and at their level you can be with your clients, the more change you can help them evoke.