This prospective cohort study in the US compared the impact of sugar-sweetened beverage (SBB) consumption versus other drinks in terms of all-cause mortality and cardiovascular disease (CVD) in people with type 2 diabetes. A total of 11 399 women and 4087 men participating in the Nurses’ Health Study or Health Professionals Follow-up Study, who either had type 2 diabetes at baseline or went on to develop the condition, were followed for up to 38 years. Participants filled in food questionnaires every 2–4 years, with a cumulative response rate of >90% in both cohorts.
Over 285 967 person-years of follow-up, there were 7638 (49.3%) deaths in the cohort. After multivariate adjustment, the hazard ratio (HR) for all-cause mortality in people drinking more than one SSB per day was 1.20 (95% CI, 1.04–1.37) compared with no SSB consumption. Higher consumption of full-fat milk (>1 serving per day vs none) was also associated with increased risk (HR, 1.20; 95% CI, 0.99–1.44).
In contrast, higher consumption of coffee (>4 servings per day vs none), tea (>2 servings), plain water (>5 servings) and low-fat milk (>2 servings) reduced the risk by 26%, 21%, 23% and 12%, respectively. Consumption of artificially sweetened beverages (ASBs) and fruit juices had no significant impact.
A total of 3447 (22.3%) participants developed CVD over 248 447 person-years of follow-up. Again, SSB consumption was associated with increased risk (HR, 1.25), while coffee (HR, 0.82) and low-fat milk (HR, 0.88) were associated with reduced risk.
Compared with participants who did not change their consumption after diabetes diagnosis, those who increased their intake of coffee, tea or low-fat milk had a lower risk of death from any cause. Replacing SSBs, fruit juice or full-fat milk with coffee, tea or plain water was associated with lower all-cause mortality. Replacing SSBs with ASBs reduced mortality and CVD risk; however, replacing ASBs with coffee, tea or plain water reduced mortality risk.
Although limited by its observational design, this study therefore emphasises the importance of beverage choices in maintaining overall health in adults with type 2 diabetes.
Attempts to achieve remission, or at least a substantial improvement in glycaemic control, should be the initial focus at type 2 diabetes diagnosis.
9 May 2024