(P18-064-23) Effects of Low-Calorie Sweetened Beverage Restriction on Glycemic Variability in Youth With Type 1 Diabetes

Objectives: Low-calorie sweeteners (LCSs) provide sweetness without sugar or calories and are commonly consumed by children with type 1 diabetes (T1D), yet their role in cardiometabolic health is unclear. We aimed to examine effects of LCS-containing beverage (LCSB) restriction for 12 weeks on glycemic variability, lipid profiles, and inflammatory biomarkers.

Methods: Children (n=31, mean age 9.8 ± 2.1 years) with T1D who reported daily LCS consumption were enrolled in a parallel arm randomized control trial. Following a two-week run-in, children (n=28) were randomized to replace LCSB with water and avoid other sources of LCSs (n=15) or continue usual LCS intake (n=13). The primary measure of interest was the between group comparison of change in glycemic variability (average daily time-in-range (TIR) over twelve weeks assessed using continuous glucose monitoring) from pre to post randomization. Other measures of glycemic variability (e.g., average glucose, HbA1c), lipid profiles, C-reactive protein, and TNF-α, were assessed at baseline and following the intervention as secondary outcomes. Linear regression of the pre-post within-subject difference, adjusted for age, sex, race, change in BMI, and baseline values for the outcome of interest, was used to compare the mean pre-post changes between groups. Statistical significance was determined using p< 0.05.

Results: Twenty-six participants (n=13 intervention, n=13 control) completed the intervention with 86% reported adherence to LCS restriction in the intervention group. No differences in change in daily average TIR or other indicators of glycemic variability (e.g., HbA1c, average glucose) were observed following LCS restriction versus usual LCS intake. However, statistically significant decreases in triglycerides, total cholesterol, LDL, and TNF-α were observed in the usual LCS intake group.

Conclusions: Twelve weeks of LCS restriction was feasible but did not improve glycemic variability or other metabolic or inflammatory biomarkers in this small sample of youth with T1D. The extent to which improvements in lipid profiles and inflammatory biomarkers in the usual LCS intake group are clinically meaningful is not yet clear as findings require further study in future trials with a larger sample size.

Funding Sources: This work was funded by the National Institutes of Diabetes and Digestive and Kidney Diseases.