9353 The Impact Of Artificially Sweetened Drinks On Metformin Efficacy

Abstract Disclosure: E. Ismail: None. A.V. Bernier: None. Title: The Impact of Artificially Sweetened Drinks on Metformin EfficacyBackground: Consumption of artificially sweetened beverages (ASB) as a recommended alternative to sugar sweetened beverages (SSB) may have a negative effect on metformin therapy for adolescents with prediabetes and obesity. A recent preclinical study showed that ASB impair release of growth differentiation factor 15 (GDF15), a hormone secreted in response to metformin therapy with an important role in glucose homeostasis and energy balance. Objectives: This translational pilot study evaluated the effect of ASB on metformin glycemic and energy balance outcomes, and metformin induced rise in GDF15.Design: Forty-six children 10-21 years with obesity and prediabetes started on metformin (500 mg twice daily), received dietary counseling to discontinue SSB and then randomized to restrict beverage intake to ASB or unsweetened beverages (USB). A beverage frequency questionnaire was collected biweekly. Anthropometric measurements, 24-hour dietary recall, hunger assessment, and lab work were obtained at baseline and 12 week follow up. Results: Of 46 participants, the mean age was 13.5 ± 2.2 years, and 54.3% were female with 54.3% Black, 10.9% Hispanic/Latino. The baseline BMI was 40.5 ± 8.5 kg/m², percent of the 95th percentile (%95th%ile) was 152.5 ± 29, and BMI z score was 3.2 ± 1.0. Thirty-six participants completed the study, with 44% in the USB group. A greater decrease in BMI [-0.55 ± 1.49 vs -0.23 ± 1.6 (p=0.6558)], %95th%ile [-3.94 ± 5.78 vs -2.28 ± 5.91 (p=0.4628)], and BMI z score [-0.12 ± 0.19 vs -0.09 ± 0.21 (p=0.7024)] was seen in the USB arm vs ASB arm though not statistically significant. A greater increase in GDF-15 was observed in the USB arm, with a mean change of 33.4 ± 58.34 vs 19.77 ± 85.87 in the ASB arm though not statistically significant (p=0.3272). A1c and dietary intake, remained similar from baseline to postintervention. There was no significant difference between groups for metformin intake.Conclusions: Initial findings of this pilot demonstrate a potential effect of dietary beverage intake on efficacy of metformin therapy on weight parameters. Although the USB arm showed small to medium decreases in BMI, %95th%ile, and BMI z score, along with an increase in GDF15 levels, no changes reached statistical significance (p < 0.05) due to the study's limited sample size and short intervention period. The recruitment of participants from a pediatric obesity clinic is not a representative sample of entire population limiting the generalizability of research findings however these results convey important need for larger studies in varied populations to clarify this salient dietary recommendation. Presentation: 6/1/2024