(OR28-04-24) The Effect of Substituting Water for Diet Beverages on Blood Pressure and Lipids in People With Type 2 Diabetes (T2D): The Study of Drinks With Artificial Sweeteners (SODAS)

Objectives: Diet beverages (DB) are the largest contributor to artificial sweetener intake in the U.S. diet. People with T2D are the highest consumers of DB, tending to consume them in place of added sugar, especially sugar-sweetened beverages. However, there is little evidence on the health impact of habitual DB consumption by people with T2D. To inform this topic we conducted a randomized trial.

Methods: The SODAS study is a two-arm parallel trial with a run-in period of 2 weeks and 24 week intervention that randomized 181 adults with T2D (HbA1c 6.5 - ≤ 8.5%), age 35+ years, who were usual consumers of commercial DB to receive and consume either: 1) A commercial DB of choice (24 oz. daily); or 2) Unflavored sparkling or flat bottled water of choice (H2O) (24 oz. daily). Outcomes include measures of clinical diabetes control and mechanisms that may alter clinical risk. Here we report preliminary secondary outcome results from clinical cardiovascular disease risk measurements. Participant’s blood pressure (systolic – SBP, diastolic – DBP) and blood lipids were measured at baseline, week 12, and week 24. We conducted an intent to treat analysis to assess the between-arm difference at week 24 using baseline adjusted repeated measures (linear mixed regression models), further adjusting for randomization strata (sex and study site).

Results: 179 participants had complete data. Participants were a mean age of 58 years, and 55% were men. At the end of the study (week 24), SBP (mm Hg) for DB was 130.9 (SE 1.0) v. 133.9 (SE 1.0) for H2O, difference of means -3.0 (95% CI -5.9, -0.1), P=0.04. At week 24 the mean DBP for DB was 76.2 (SE 0.6) v. 76.9 (SE 0.5) for H2O, difference of means -0.7 (95% CI -2.2, 0.8), P=0.4. The mean LDL cholesterol (mg/dL) for the DB group at week 24 was 85.1 (SE 1.7) vs. 80.6 (SE 1.6) for the H2O group, difference of means 4.5 (95% CI, -0.2, 9.1), P=0.06. The mean HDL cholesterol (mg/dL) for the DB group at week 24 was 49.5 (SE 0.4) v. 48.6 (SE 0.4) for the H2O group, difference of means 0.9 (95% CI -0.3, 2.2), P=0.14. The mean week 24 triglycerides (mg/dL) for the DB group were 152.7 (9.0) v.168.8 (8.5) H2O, difference -15.9 (-40.7, 9.0), P=0.21.

Conclusions: Preliminarily, in people with T2D who habitually consumed DB, those randomized to substitute H2O for DB had higher SBP, lower LDL cholesterol and no differences in HDL or triglycerides after 24 weeks.

Funding Sources: NIH