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Can your beverage choices impact diabetes outcomes?

In a recent study published in BMJ, researchers investigate how the consumption of various types of beverages impacts the incidence of cardiovascular disease (CVD) and mortality among patients with type 2 diabetes.


Recent estimates indicate that over 500 million adults throughout the world have diabetes. Individuals with type 2 diabetes are at a higher risk of comorbidities such as CVD and premature mortality.

The glycemic management in type 2 diabetes patients depends largely on dietary interventions. However, nutritional guidelines and recommendations applicable to the general public might not be relevant for individuals with type 2 diabetes. Thus, evaluating the impact of dietary components such as beverages on mortality rates and disease outcomes in type 2 diabetes patients is crucial.

Different beverages' effects on health outcomes depend on the sugar content and other constituents in the beverages. Meta-analyses have reported that consumption of beverages with low sugar content, such as water, coffee, and low-fat milk, is associated with a lower incidence of CVD, obesity, mortality, and type 2 diabetes in the general population.

Comparatively, beverages sweetened with sugar have been linked to an increase in the incidence of these diseases. However, the impact of individual beverage consumption on the incidence of CVD or mortality among individuals diagnosed with type 2 diabetes remains unclear.

About the study

In the present study, researchers use data from one study on a prospective cohort of female nurses between the ages of 30 and 55 years and another cohort study on male health professionals between the ages of 40 and 75 years initiated in 1976 and 1986, respectively. The data comprised detailed information on factors associated with diet, lifestyle, disease status, and medical history.

Participants diagnosed with type 2 diabetes at baseline or during the follow-up period were included in the study. Those with type 1 diabetes, cancer, or CVD at baseline or before being diagnosed with type 2 diabetes at follow-up were excluded.

A food frequency questionnaire, which was administered at intervals of two to four years, was used to determine beverage intake of the participants.

The frequency and type of beverages consumed were queried, including sugar-sweetened beverages, artificially sweetened beverages, tea, coffee, low-fat milk, fruit juices, and water. Sugar-sweetened drinks included caffeinated and noncaffeinated colas, carbonated beverages, and non-carbonated drinks such as lemonades and other fruit.

The primary evaluated outcome was all-cause mortality, while secondary outcomes included the incidence of CVD and mortality. Mortality was reported by next of kin, and the international classification of diseases, ninth revision codes were used to classify the cause of mortality as CVD, cancer, or other causes. Non-fatal and fatal stroke and coronary heart disease, as well as surgery for coronary artery bypass grafts, were included in incident CVD.

Study findings

An increased intake of beverages sweetened with sugar was associated with a higher CVD incidence and risk of all-cause mortality, while the consumption of water, tea, coffee, and low-fat milk had an inverse association with all-cause mortality. Similarly, an increase in the consumption of tea and coffee after the diagnosis of type 2 diabetes was linked to a significantly lower incidence of all-cause mortality.

The all-cause mortality pooled hazard ratios were 1.20, 0.96, 0.98, 0.79, 0.74, 0.77, 0.88, and 1.20 for sugar-sweetened beverages, artificially sweetened beverages, fruit juice, tea, coffee, water, low-fat milk, and full-fat milk, respectively. Hazard ratio patterns were similar for CVD incidence, with a greater likelihood of CVD and mortality associated with higher consumption of sugar-sweetened beverages with hazard ratios of 1.25 and 1.29, respectively.

The risk of all-cause mortality and CVD incidence was lower for individuals who replaced sugar-sweetened beverages, artificially sweetened beverages, full-fat milk, and fruit juices with water, tea, or coffee after being diagnosed with type 2 diabetes.


The results suggest that individual beverages have varying associations with the risk of all-cause mortality and CVD in type 2 diabetes patients.

A high intake of beverages sweetened with sugar or artificial sweeteners increased the all-cause mortality rate and the incidence and mortality associated with CVD. Replacing these beverages with plain water, tea, or coffee reduced the all-cause mortality risk.

Taken together, these findings highlight the importance of healthy beverage choices in managing type 2 diabetes.

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