Poster Presentation The Annual Scientific Meeting of the Australian Diabetes Society and the Australian Diabetes Educators Association 2013

A Bitter-Sweet Lesson (#334)

Lisa Simmons 1 , Robyn Gray
  1. RPA Medical Centre, Newtown, NSW, Australia

Consumption of sugar sweetened beverages including soft drinks, fruit drinks, iced tea, energy and vitamin water has risen globally. It has been associated with weight gain, obesity, metabolic syndrome and an increased incidence of type 2 diabetes (T2DM)(1, 2). This is thought to be due to weight gain as well as increased dietary glycaemic load causing rapid spikes in glucose and insulin, leading to insulin resistance, β-cell dysfunction, and inflammation(2, 3, 4).

We report the case of a 36yo old male who presented with weight loss, polyuria, polydipsia and blurred vision. His diet included a high intake of sugar sweetened beverages(>1.5L/day) and high levels of food sweeteners such as sucrose and high-fructose corn syrup. His physical examination was unremarkable.

Blood test results showed normal FBC,EUC,LFTs. His HbA1c was 11.1% with a fasting plasma glucose of 16.2 mmol/L. A diagnosis of diabetes was made with consideration given to Type 1 diabetes given his age, symptoms and the severity of recent onset hyperglycaemia. GAD, IA-2, insulin and islet cell antibodies were negative.

He was commenced on insulin therapy. After several months of treatment together with cessation of sugary drinks, adherence to a healthy diet and regular exercise, insulin was discontinued. The patient was transferred to oral hypoglycaemics, subsequently ceased due to hypoglycaemia.

Nine months following his diagnosis the patient's HbA1c was normal at 5.8 %.  Two-hour-111223 OGTT confirmed a diagnosis of diabetes, although well controlled, with a fasting level of 6.2 mmol/L and a 2-hour level of 11.3 mmol/L. The patient remains well off medical therapy.

This case together with recent studies, demonstrate that high consumption of sugar sweetened beverages is associated with development of metabolic syndrome and type 2 diabetes.

Much can be learnt from this case with regards to the adverse effects of soft drink and sugar intake as well as the importance of maintaining a healthy diet low in added sugars.

  1. Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care. 2010 Nov;33(11):2477-83. doi: 10.2337/dc10-1079. Epub 2010 Aug 6. Review.
  2. The InterAct consortium. Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct. Diabetologia. 2013 Apr 26. [Epub ahead of print].
  3. Malik VS, Schulze MB, Hu FB (2006) Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 84:274–288
  4. Hu FB, Malik VS (2010) Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav 100:47–54