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Completed

NCT Number: NCT03944616

Study Of Drinks With Artificial Sweeteners in People With Type 2 Diabetes

Diet beverages sweetened with artificial sweeteners occupy a unique category in the food environment as they are a source of intensely sweet taste with no calories. Diet beverages are the single largest contributor to artificial sweetener intake in the U.S. diet, and people with diabetes are the highest consumers of diet beverages, tending to consume them as a replacement for dietary sources of sugar, especially in place of sugar-sweetened beverages. This behavior has been endorsed by dietetic and scientific organizations, and diet beverages are marketed as being synonymous with better health, suitable for weight loss, and thus advantageous for diabetes control. The underlying public health concern is that there are few data to support or refute the benefit or harm of habitual diet beverage consumption by people with diabetes; therefore randomized trials with relevant outcomes must be conducted because they would address many limitations of previous research and have major implications for dietary recommendations on diet beverage intake and primary and secondary prevention of chronic disease. To begin addressing this important scientific gap the investigators are testing the effect of diet beverage intake on diabetes control parameters in free-living adults with type 2 diabetes in a randomized, two arm parallel trial with a run-in period of 2-weeks and an active intervention period of 24-weeks. This study will recruit 200 patients with type 2 diabetes who are usual consumers of commercial diet beverages and randomize them to receive and consume either: 1) A commercial diet beverage of choice (3 servings or 24 oz. daily); or 2) Unflavored bottled water of choice (sparkling or plain) (3 servings or 24 oz. daily). The primary outcome will be a central measure of clinical diabetes control in glycated hemoglobin (HbA1c). The study will also measure the nature and magnitude of glycemic excursions via continuous glucose monitors, as well as clinical markers of cardiometabolic risk and kidney function. Lastly, investigators will measure plausible mechanisms whereby diet beverage intake may alter risk by assessing the effect of diet beverage intake on the functional composition of the gut microbiome via stool samples and comprehensive metabolomics, satiety hormones, as well as usual dietary intake, and upstream behavioral pathways which may inform dietary intake patterns.

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Key information

Age range

35 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

University of California, Irvine, Irvine, California, United States

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Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

We will include men, women and non-binary participants with T2D, age 35 years and older, able to provide informed consent, otherwise healthy, who meet the following criteria:

  • Physician diagnosed type 2 diabetes ≥ 6 months prior to screening
  • HbA1c 6.5-8.5% at participant screening
  • Current treatment with lifestyle changes or stable diabetes-related medication levels for the past 3 months
  • Willingness to provide consent to contact treating physician and physician agreement to refrain from changing diabetes-related medications during the trial (change defined as > 2 fold change in dose of any 1 hyperglycemic agent or addition or subtraction of an agent)
  • No physician-directed medication change for 3 months if prescribed medication for lipids or blood pressure
  • Usual consumers of diet beverages (≥ 3 servings/ week (24 oz.) and the willingness to maintain fidelity of the intervention, and participate in all aspects of the intervention
  • Not actively looking to make major lifestyle alterations during the study period with stable weight for 2 months (within 3%).

Exclusion criteria

  • Type 1 diabetes or suspected type 1 diabetes (lean with polyuria, polydipsia, and weight loss with little response to metformin)
  • "Secondary" diabetes due to specific causes (e.g. monogenic syndromes, pancreatic surgery, and pancreatitis)
  • Diabetic Ketoacidosis hospitalization within last 6 months
  • Severe/major hypoglycemia in the last 3 months-severe/major hypoglycemia is defined as a hypoglycemic event in which patient requires assistance of another person to manage the episode
  • Glucocorticoid use (prednisone 2.5 mg/d or more or its equivalent)
  • History of intolerance or allergy to diet beverages or AS or phenylketonuria
  • Any condition that is known to affect the validity of the glycemic measures (Hba1c)
  • Major cardiovascular disease event or surgery within past 6 months
  • Gastrointestinal disease
  • Renal or liver disease
  • Current treatment for cancer
  • Those with major surgery planned or history of bariatric surgery
  • Antibiotic treatment (> 6 days) within past 6 months
  • Currently pregnant (via self-report) or planning to become pregnant during study period; <1 year postpartum and breast feeding
  • Current participation in another interventional clinical trial
  • Previous randomization in this study,
  • Heavy alcohol consumption (on average >2 drinks/day for women and >3 drinks/day for men)
  • Habitual consumer of SSB ≥ 1 serving / day (8 oz.)
  • Does not drink diet beverages
  • BMI < 20.0 kg/m2

Treatment and study plan

Diet Beverage

Behavioral

Participants will receive and consume three daily servings (24 ounces) of a non-caloric commercial diet beverage of their choice sweetened with FDA approved artificial sweeteners.

Water

Behavioral

Participants will receive and consume three daily servings (24 ounces) of plain bottled/canned water in place of their usual commercial diet beverage. The water will be unflavored, unsweetened, non-caloric, and may be plain or sparkling. Participants randomized to consume water will be instructed to avoid intake of diet beverages.

Primary outcomes

  1. HbA1c

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    Glycated hemoglobin

Secondary outcomes

  1. Time In Range

    Time frame: All 14 day periods: Run-in (2-weeks, usual-baseline), weeks 11 and 12 (14 days), weeks 23 and 24 (14 days)

    Time in range is collected by a masked Continuous Glucose Monitor (CGM), which measures individual glucose levels every 15 minutes for two weeks via a sensor placed on the participants upper arm (underside). Time in Range is defined as the % of time each day with a glucose measure between 70-180 mg/dl. The range of CGM data for inclusion in this study will be 5 to 14 days, consistent with manufacturer's recommendations.

  2. Glycemic Variability

    Time frame: All 14 day periods: Run-in (2-weeks, usual-baseline), weeks 11 and 12 (14 days), weeks 23 and 24 (14 days)

    Glycemic variability is collected by a masked Continuous Glucose Monitor (CGM), which measures individual glucose levels every 15 minutes for two weeks via a sensor placed on the participants upper arm (underside). Glycemic variability is defined as the Standard Deviation (SD) of the mean glucose during the wear period. The range of CGM data for inclusion in this study will be 5 to 14 days, consistent with manufacturer's recommendations.

  3. Mean Glucose (mg/dl)

    Time frame: All 14 day periods: Run-in (2-weeks, usual-baseline), weeks 11 and 12 (14 days), weeks 23 and 24 (14 days)

    A measure of the mean, 24 hour glucose concentration calculated across all recorded glucose readings during the wear period

  4. Fasting Glucose

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    Standard (mg/dl) measure taken fasting (morning) during baseline, 12 weeks, 24 weeks

  5. Fasting Insulin (Pmol/L)

    Time frame: Time 0 (directly after 2-week run-in), week 12, week 24

    Standard lab measurement for fasting insulin assessment

  6. Fructosamine

    Time frame: Time 0 (directly after 2-week run-in),12, 24 weeks

    Fructosamine (umol/L) represents usual glycemia over the past 2-3 weeks, and is considered a valid marker of short term clinical glycemic patterns by the American Diabetes Association

  7. Weight (kg)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    Weight measured on standardized scale in gown

  8. Total Cholesterol (mg/dL)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    Total cholesterol was measured as part of a lipid panel, a standard measurement for assessing clinical CVD risk

  9. Kidney Function

    Time frame: Time 0 (directly after 2-week run-in),12, 24 weeks

    eGFR-Cystatin-C (estimated glomerular filtration rate) = mL/min/1.73 m^2

  10. Systolic Blood Pressure

    Time frame: Time 0 (directly after 2-week run-in),12, 24 weeks

    Systolic blood pressure (mmHg)

  11. Diastolic Blood Pressure

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    Standard part of blood pressure measurement (mmHG)

  12. Apolipoprotein-AI

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    Apo-AI the major protein component of high density lipoprotein (HDL)

  13. Apolipoprotein B

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    ApoB levels indicate the atherogenic particle concentration independent of the particle cholesterol content

  14. Fibrinogen (mg/dL)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    A protein involved in forming blood clots in the body

  15. C-reactive Protein

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    biomarker of inflammation

  16. Aspartate Aminotransferase (AST) (U/L)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    AST (aspartate aminotransferase) is an enzyme that reflects liver function

  17. Aminotransferase (ALT) (U/L)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    ALT (alanine transaminase) is an enzyme, a protein that reflects liver function

  18. Alkaline Phosphatase (ALKPhos ) (U/L)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    ALP is an enzyme, a protein, that reflects liver function

  19. Thyroid Stimulating Hormone (TSH)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    Hormone measured in the blood with energy balance related role

  20. Dietary Quality (Healthy Eating Index -HEI)

    Time frame: Run-in period (2 weeks) - baseline, Week 1-12 (period 1), Week 13-24 (period 2).

    The Healthy Eating Index (HEI) is a measure of diet quality used to assess how well a set of foods aligns with key recommendations and dietary patterns published in the Dietary Guidelines for Americans (Dietary Guidelines). The overall HEI scores are made up of 13 components that reflect the different food groups and key recommendations in the Dietary Guidelines for Americans. The HEI is scored 0-100 (low to high), with higher scores representing greater reported intake of an overall dietary pattern aligning with USDA Dietary Guidelines. In the SODAS study, dietary intake was assessed by multiple unannounced 24-hour dietary recalls that occurred during the 2-week run-in period to assess usual habits (2 recalls over 2 weeks) and the active intervention (5 recalls over 24 weeks: 2 to 3 recalls during weeks 1-12 (period 1), and 2 to 3 recalls during weeks 13-24 (period 2). to measure any changes in diet quality. Scores during each period represent the average score of recalls.

  21. The Diabetes Health Profile (DHP-18)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    The Diabetes Health Profile (DHP-18) is used to assess health related quality of life in diabetes across three domains (psychological distress, barriers to activity and disinhibited eating). Each item is scored on a 4-point scale, and the subscale scores are then rescaled to a 0-100 range, with higher scores indicating poorer well-being.

  22. Food Craving Inventory (FCI)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    The FCI is a valid and reliable self-report measure of specific food cravings. The inventory consists of 4 factors or subscales measuring cravings for high fats (8 items), carbohydrates/starches (8 items), sweets (8 items), and fast food fats (4 items), and a total score is calculated by summing the subscales. Participants rate each food on a 5-point Likert scale ranging from 0 (never) to 4 (always/almost every day). We calculated the total score by summing the individual item responses in each subscale. Higher scores indicate more frequent cravings of the 28 items.

  23. The Pittsburgh Sleep Quality Index (PSQI)

    Time frame: Time 0 (directly after 2-week run-in), 12, 24 weeks

    The Pittsburgh Sleep Quality Index (PSQI) is a self-report questionnaire that assesses sleep quality over a one-month time interval. Each component score of the PSQI ranges from 0 to 3, with 3 indicating the greatest dysfunction or disturbance. The seven component scores are then summed to obtain a global PSQI score, which ranges from 0 to 21. Higher scores indicate poorer sleep quality, with a score greater than 5 suggesting significant sleep difficulties

  24. Medication Effect Score (MES)

    Time frame: Time 0 (directly after 2-week run-in), 6, 12, 18, 24 weeks

    The medication effect score (MES) is a measure of overall diabetes regimen intensity, and is based on the dosages of medications used and their potencies. The MES is calculated for each diabetes medication in a regimen using the following equation: (actual drug dose/maximum drug dose) × drug-specific adjustment factor. The adjustment factor equates to the expected decrease in HbA1c achieved by the drug as monotherapy. The MES presumes a linear relationship between medication dosage and HbA1c, and the sum of MES values attributed to individual medications represents the maximum A1c reduction that may be expected by the regimen. It is a continuous variable with range 0 (no medications), and the maximum achievable MES is patient specific and dependent on the total number of and dose of medications reported.

  25. Therapeutic Intensity Score (TIS)

    Time frame: Time 0 (directly after 2-week run-in), 6, 12, 18, 24 weeks

    The therapeutic intensity score (TIS) is a summary measure that accounts for the number of medications and the relative doses a patient received to lower blood pressure. It is a continuous variable with range 0 (no medications), and the maximum achievable TIS is patient specific and dependent on the total number of antihypertensive medications reported.

Sponsors and collaborators

Lead sponsor

University of California, Irvine

Other

Collaborators

  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
  • University of Minnesota

Registry information

Official study title

Effect of Artificially Sweetened Beverages on Diabetes Control in Adults With Type 2 Diabetes

Acronym: SODAS

Important dates

Study start
2019
Primary completion
2024
Study completion
2024
First posted
May 9, 2019
Registry last updated
Sep 11, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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