Abstract. This article examines and summarizes studies on the epidemiology, risk of developing diabetes, and the influence on the cardiovascular system of patients with diabetes and different levels of alcohol consumption. High costs for the treatment of alcohol abusers have been demonstrated. The article describes the effect of ethanol on glucose metabolism and the mechanisms that cause hyperglycemia and hypoglycemia, the role of ghrelin and leptin in alcohol-consuming patients with diabetes mellitus. Attention is paid to the issues of hypocoagulation and systemic inflammation in diabetics who use ethanol. The effect of alcohol on patients with type 1 diabetes mellitus is shown separately. The influence of alcohol on the development of atherosclerosis, as well as late complications of diabetes mellitus, such as diabetic angiopathy of the lower extremities, is described. The influence of alcoholic beverage preferences on the risk of developing diabetes mellitus has been demonstrated. Low adherence to self-control in ethanol-consuming patients with diabetes mellitus is emphasized.Drinking small or medium amounts of alcohol has been shown to reduce the incidence of diabetes in most studies, while heavy drinkers are at an increased risk of developing the disease. In people with diabetes, light to moderate alcohol consumption reduces the risk of cardiovascular disease and all-cause mortality. The type of alcoholic drink, gender, and probably body mass index are factors that influence these results. For citation: Morgunov L. Yu. Аlcohol and diabetes: a double-edged stick // Lechaschy Vrach. 2021; 3 (24): 10-15. DOI: 10.51793/OS.2021.24.3.002