Long-Term Increases in Sugary Drink Consumption & Diabetes Risk

What does artificially sweetened or sugary drink consumption, at consistently increasing amounts, mean for patients’ long term health?

Sugary and artificially sweetened beverages are arguably two of the worst drink choices to institute into a diet, whether a person is a patient with diabetes or not. Many studies have linked both to obesity, increased episodes of hyperglycemia, and other cardiometabolic risk factors. Pure fruit juices were once considered a healthy choice, but studies have shown that they contain just as much sugar as a soda or sports drink. A recent randomized control study demonstrated that replacing sugary beverages with artificially sweetened beverages has beneficial effects on the body, but shortly after this finding, a meta-analysis was published which linked long-term consumption of artificially sweetened beverages to increased risk of developing diabetes. To date, however, there has not been a study that has evaluated whether longitudinal changes in the way a person consumes sugary or artificially sweetened beverages are associated with a subsequently increased risk of developing type 2 diabetes. A recent study sought to do just that. In the study, the associations between changes in consumption of sugary beverages (total, 100% fruit juices, and sugar sweetened beverages [SSBs]) and artificially sweetened beverages were evaluated concerning the subsequent risk of type 2 diabetes.

The major goal of the study was to determine if there were true long-term associations between changes in the consumption of sugary (sugar-sweetened and 100% fruit juices) and artificially sweetened beverages (ASBs) with the subsequent risk of developing type 2 diabetes. Three large prospective cohorts of both men and women were evaluated concerning this objective. The NHS is a prospective cohort study of 121,701 female registered nurses in the US. They were aged 30-55. The NHS II is another prospective cohort study which was made of 116,430 registered female nurses between the age of 25 and 42. The HPFS was a prospective cohort study that consisted of 51,529 U.S. male health professionals aged 40-75. All three of these studies are ongoing, and approximately 10% of patients randomized lost to follow-up. Changes in the patient beverage consumption were calculated using food frequency questionnaires, which were administered to each cohort every four years. The serving was defined as 8 ounces with the patient indicating their approximate intake per day. A cox multivariable proportional regression model was used to find hazard ratios for the occurrence of diabetes associated with those participants that indicated changes in their beverage consumption. From there, all of the results from the three large cohorts were pooled. This was done using an inverse variance-weighted, fixed-effect meta-analysis.

At the identified intervals of follow-up, there were 11,906 confirmed cases of type 2 diabetes. There were adjustments made for initial patient BMI as well as changes in diet and lifestyle habits. It was found that a person increasing their sugary beverage intake (sugar-sweetened beverages and 100% fruit juice) by greater than half a serving per day over four years has a 16% higher chance of developing diabetes in the future (95% CI 1%, 34%). Participants who increased their artificially sweetened beverage consumption by greater than half a serving per day were found to be 18% more likely to develop diabetes. The meta-analysis also revealed that participants who replaced just one sugary beverage serving with either water, coffee, or tea, not any artificially sweetened beverage, had about a 3-10% lower risk of a future diabetes diagnosis. The major weakness of the study was the fact that there was some room for both surveillance bias and reverse causation. While an association can be identified, any causal relationship would require further studies.

This meta-analysis revealed that there is, in fact, a relationship between increasing a person’s consumption of sugary beverages and artificially sweetened beverages and future diagnosis of diabetes. Long-term changes in the way a person consumes any sugary beverage can increase a patient’s risk of developing diabetes. Clinicians should always emphasize the importance of limiting the consumption of beverages containing both pure or artificial sugars to help combat the increasing rate with which diabetes is being diagnosed in the United States. Even just switching out one serving a day can drastically improve a patient’s risk in the long-term.

Practice Pearls:

• Long term consumption of sugary or artificially sweetened beverages increased a person’s risk of developing diabetes.
• All patients in the clinical setting should be encouraged to avoid both sugary and artificially sweetened beverages to prevent negative impacts on their health.
• If patients are unwilling to eliminate these beverages, switching one serving per day to either coffee, tea, or water can provide some positive benefits.

Reference for “Long-Term Increases in Sugary Drink Consumption & Diabetes Risk”:
Drouin-Chartier J-P, Zheng Y, Li Y, et al. Changes in Consumption of Sugary Beverages and Artificially Sweetened Beverages and Subsequent Risk of Type 2 Diabetes: Results From Three Large Prospective U.S. Cohorts of Women and Men. Diabetes Care. 2019;42(12):2181-2189. doi:10.2337/dc19-0734.

Jordan Boyd, PharmD. Candidate of Florida Agricultural & Mechanical University School of Pharmacy

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