Can consuming excessive sugar lead to the development of type 2 diabetes?

Can Excessive Sugar Consumption Cause Diabetes?

Excessive sugar consumption alone does not directly cause diabetes, but it contributes significantly to obesity and weight gain, which are major risk factors for developing type 2 diabetes. 1

Relationship Between Sugar Consumption and Type 2 Diabetes

• Obesity, physical inactivity, and increasing age are the major risk factors for developing type 2 diabetes, with relative risks increased 4-12 fold by being overweight or obese 1
• Sugar-sweetened beverages (SSBs) consumption is associated with a 20% increased risk of type 2 diabetes per daily serving, and is projected to account for 1.8 million new cases of type 2 diabetes in the US over the next 10 years 1
• High consumption of SSBs shows an increased relative risk of about 0.2-0.3 for developing type 2 diabetes compared to low consumers 1
• Further analysis of soft drink consumption found a 0.13 increase in risk for each serving of SSB and a 0.08 increase for each serving of artificially sweetened beverage 1

Pathophysiological Mechanisms

• Type 2 diabetes involves progressive loss of insulin secretion from pancreatic β-cells in the setting of insulin resistance, manifesting clinically as hyperglycemia 2
• In individuals with type 2 diabetes, especially those with obesity, insulin resistance in target tissues (liver, muscle, adipose tissue) is a prominent feature, resulting in both glucose overproduction and underutilization 1
• Abnormal islet cell function is a key and requisite feature of type 2 diabetes, with insulin production being disproportionately low for the degree of insulin sensitivity 1
• The functional islet incompetence is the main quantitative determinant of hyperglycemia and progresses over time 1

Sugar-Sweetened Beverages and Diabetes Risk

• SSBs represent the largest single source of added sugar in average American diets and account for 50-90% of the recommended daily limit of added sugars 1
• Nearly two-thirds of US children and youth consume at least one SSB per day, with highest intake levels observed among adolescents, groups with lower socioeconomic status, and non-Hispanic Blacks and Hispanics 1
• The high consumption of SSBs and increasing prevalence of obesity in younger adults suggests that SSBs will contribute to type 2 diabetes in the future 1
• A workplace SSB sales ban study found that among daily SSB consumers, mean daily intake decreased by approximately 50% after 10 months, with reductions correlating with improvements in waist circumference 1

Other Dietary Factors and Diabetes Risk

• Meta-analysis of prospective cohort studies shows increased risk of type 2 diabetes associated with high consumption of white rice, processed meat, and red meat 1
• Lower risk of type 2 diabetes is associated with consumption of dairy products, green leafy vegetables, wholegrains, coffee, and alcohol 1
• Fruit consumption of 200-300g/day decreased risk of type 2 diabetes by 10%, with no additional benefit for higher intake 1
• Consumption of berries was associated with an 18% reduction in risk of type 2 diabetes 1

Prevention Strategies

• In adults with overweight or obesity at high risk of type 2 diabetes, care goals should include weight loss and maintenance, minimizing the progression of hyperglycemia, and attention to cardiovascular risk 1
• More intensive preventive approaches should be considered in individuals who are at particularly high risk of progression to diabetes, including those with BMI ≥35 kg/m², higher glucose levels, and history of gestational diabetes mellitus 1
• Regular physical activity approximately halves the risk of developing type 2 diabetes 1
• Replacing SSBs with water in institutions and homes has shown promise in reducing obesity and diabetes risk 1

Clinical Implications

• For patients already diagnosed with type 2 diabetes, dietary guidelines have been shifting away from numerical targets for macronutrients towards advocating a change in dietary pattern 1
• Mediterranean and vegetarian dietary patterns have favorable effects on cardiovascular disease risk in diabetes patients 1
• Dietary guidelines focus on reducing salt, added sugar, saturated and trans fatty acid intakes, and increasing intakes of potassium and fiber 1
• Pharmacotherapy for weight management and minimizing the progression of hyperglycemia should be considered to support person-centered care goals in high-risk individuals 1

Important Caveats

• The current epidemic of type 2 diabetes is mainly affecting those over 50 years old, who are not the major consumers of SSBs 1
• Insulin resistance can be identified through various tests, including fasting plasma glucose (100-125 mg/dL indicating impaired fasting glucose), oral glucose tolerance test (140-199 mg/dL at 2 hours indicating impaired glucose tolerance), and hemoglobin A1C (5.7-6.4% suggesting prediabetes) 3
• Type 2 diabetes is diagnosed if fasting plasma glucose is ≥126 mg/dL, hemoglobin A1C is ≥6.5%, or 2-hour glucose during 75-g oral glucose tolerance testing is ≥200 mg/dL 2
• The relationship between sugar consumption and diabetes is complex, with excess energy intake followed by excess body fat gain being most relevant in the development of type 2 diabetes 4