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As the epidemiology of this disease constitutes a larger percentage of the American population, another factor presents a dangerous dilemma that can exacerbate the hazardous effects imposed by <jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content>. Excessive alcohol consumption concerns the health of more than 50% of all adults. When this heavy\u2010alcohol\u2010drinking population overlaps with <jats:styled-content style=\"fixed-case\">DM<\/jats:styled-content> and its complications, the effects can be dangerous. In this review, we term it as \u201cdouble trouble.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We provide evidence of alcohol\u2010induced exacerbation of organ damage in diabetic conditions. In certain cases, we have explained how diabetes and alcohol induce similar pathological effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Known exacerbated complications include those related to heart diseases, liver damage, kidney dysfunction, as well as retinal and neurological impairment. Often, pathophysiological damage concludes with end\u2010stage disorders and even mortality. The metabolic, cell signaling, and pathophysiological changes associated with \u201cdouble trouble\u201d would lead to the identification of novel therapeutic targets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This review summarizes the epidemiology, diagnosis, pathophysiology, metabolic, and cell signaling alterations and finally brushes upon issues and strategies to manage the \u201cdouble trouble.\u201d<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.13008","type":"journal-article","created":{"date-parts":[[2016,3,25]],"date-time":"2016-03-25T10:54:48Z","timestamp":1458903288000},"page":"686-697","source":"Crossref","is-referenced-by-count":32,"title":["Alcohol Toxicity in Diabetes and Its Complications: A Double Trouble?"],"prefix":"10.1111","volume":"40","author":[{"given":"Srikar","family":"Munukutla","sequence":"first","affiliation":[{"name":"Division of Hypertension and Vascular Research Department of Internal Medicine Henry Ford Health System 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