Sugar-sweetened beverages linked with increased risk of premature death from Type 2 diabetes, study flags

20 Apr 2023 --- Regular consumption of sugar-sweetened drinks is linked to higher incidences of heart disease-related mortality among people with Type 2 diabetes, while alternative healthier beverages like coffee, tea, low-fat cow’s milk and plain water are associated with an up to 18% lower risk of all-cause mortality, a new study reveals.

The Harvard T.H. Chan School of Public Health researchers found that each daily serving of a sugar-sweetened beverage is associated with an 8% higher risk of all-cause mortality among those with Type 2 diabetes

Researchers highlight that this is one of the first large-scale studies to examine associations between beverage consumption, all-cause mortality and cardiovascular disease mortality, specifically among people with Type 2 diabetes.

“Beverages are an important component of our diet and the quality can vary hugely,” says the study lead author Qi Sun, associate professor in the Departments of Nutrition and Epidemiology at Harvard T.H. Chan.

“People living with diabetes may especially benefit from drinking healthy beverages – but data has been sparse. These findings help fill in that knowledge gap and may inform patients and their caregivers on diet and diabetes management.”

Soda intake was associated with a 25% higher risk of cardiovascular disease and a 29% higher mortality risk.“People living with diabetes should be picky about how they keep themselves hydrated.”

Go to beverages
In the study, high intakes of certain beverages – up to six servings per day – have been found to lower mortality in general. By drinks, the reduction observed is 26% for coffee, 21% for tea, 23% for plain water and 12% for low fat.

The significantly lower mortality for coffee and tea might be partially due to higher average wealth and better access to health resources and nutritious diets among people that consume them. Furthermore, observational studies fail to adjust for participant levels of physical activity or how these beverages are consumed, such as with added sugars or snacks.

“This is an observational study, so it can’t establish cause and the researchers acknowledge that individual beverage consumption may be linked to other dietary and lifestyle risk factors for cardiovascular disease and mortality among adults with diabetes and they can’t rule out the possibility that measurement errors or misclassification may have influenced the results,” explain the authors.

“However, this was a large study with a long follow-up period, high response rates, and detailed and repeated assessments of dietary and lifestyle variables before and after a diabetes diagnosis,” they underscore. 

Study methodology
The study analyzed 18.5 years of health data from over 15,486 US participants diagnosed with Type 2 diabetes.

The participants reported on how often they consumed SSBs, artificially sweetened beverages, fruit juice, coffee, tea, low-fat cow’s milk, full-fat cow’s milk and plain water every two to four years. Frequent coffee drinking leads to the lowest observed mortality rates.

The research was funded by the National Institutes of Health grants.

Questions remain for further study, flags Nita Forouhi, program leader of the MRC Epidemiology Unit at the University of Cambridge, such as the effect of adding sugar to coffee or tea and the impact of other popular drinks like milkshakes, smoothies and hot chocolate. 

“It is also unclear whether the findings apply to different population groups as the study focused on predominantly white US health professionals.”

Nevertheless, choice of beverage clearly matters, she says. “The case for avoiding sugar-sweetened beverages is compelling in the general population and it is reasonable to shift the focus to drinks that are most likely to have positive health effects: coffee, tea, plain water, and low-fat milk.”

This new study extends our understanding of the health implications of different beverages to adults with Type 2 diabetes, she concludes.

By Marc Cervera