Benefits for people with diabetes

Low/no calorie sweeteners cause a lower rise in blood glucose levels after meals (post-prandially) if consumed instead of sugars and do not otherwise affect blood glucose control or insulin secretion.1,2,3 The benefit of low/no calorie sweeteners on post-prandial glucose has also been recognised as a health claim by the European Food Safety Authority (EFSA): “Consumption of foods containing low/no calorie sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods”.1

Low/no calorie sweeteners offer more “sweet” food choices to people with diabetes

Diabetes is one of the fastest growing health challenges of the 21st century, with the number of adults living with diabetes having more than tripled since 2000. Based on the latest figures released by the International Diabetes Federation (IDF) in IDF Diabetes Atlas 2021, it is estimated that globally 1 in 10 adults aged 20-79 years, a staggering 537 million people, are currently living with diabetes.4 If trends continue, IDF estimates that the number of adults living with diabetes worldwide will rise to 783 million by 2045. A further 1.2 million children and adolescents under the age of 20 live with type 1 diabetes.4

Low/no calorie sweeteners offer people with diabetes broader food choices by providing the pleasure of sweet taste without raising blood glucose levels.2,3 As low/no calorie sweeteners have no impact on insulin and blood sugar levels and do not provide calories, they can also have a role to play in weight loss and weight control for people with diabetes.5-10

The role of low/no calorie sweeteners in diabetes

Over the last decade, numerous diabetes-related organisations worldwide, including the American Diabetes Association (ADA), the Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), Diabetes UK, Diabetes Canada, and the Latin-American Association of Diabetes (Asociación Latinoamericana de Diabetes – ALAD) have issued clinical practice and nutritional guidelines, position statements or consensus reports about the use of low/no calorie sweeteners in diabetes.5-10

The latest evidence- based European recommendations for the dietary management of diabetes, published in 2023, recommend the use of low/no calorie sweeteners to replace sugars in foods and beverages, while the intake of free or added sugars is advised to be below 10% of total energy intake.5 The European recommendations on sweeteners are based on a series of systematic reviews and meta-analyses of Randomized Control Trials (RCTs)11 and prospective cohort studies12 assessing the impact of low/no calorie sweetened beverages on cardiometabolic health in people with or at risk of developing diabetes. The two studies concluded that low/no calorie sweetened beverages, when replacing sugar-sweetened beverages, reduce body weight and cardiometabolic risk factors in people with or at risk for diabetes11 and are associated with reductions in the risk of obesity and cardiovascular outcomes in participants inclusive of people with diabetes, with reductions similar to those seen with the standard of care, water.12

A Consensus Report on “Nutrition therapy for adults with diabetes or prediabetes” by the American Diabetes Association (ADA) stated that replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories, but people should be counselled to avoid compensating with intake of additional calories from other food sources.6 In the 2024 update of Medical Nutrition Therapy recommendations, ADA supported the use of non-nutritive sweeteners as a replacement for sugar-sweetened products in moderation if it reduces overall calorie and carbohydrate intake.7

Similarly, other organisations including the Latin-American Association of Diabetes (Asociación Latinoamericana de Diabetes – ALAD)8, Diabetes UK9, and Diabetes Canada10 recognise the role of low/no calorie sweeteners in calorie reduction, weight and glucose control, when used to replace sugar as part of a healthy dietary plan.

For more information on the role of low/no calorie sweeteners in diabetes management we invite you to download the ISA factsheet Sweet talk on diabetes: how can low/no calorie sweeteners help? and the ISA infographic Low Calorie Sweeteners in Diabetes.

You may also find interesting to check the online materials developed over the years as part of the ISA online campaigns in support of World Diabetes Day, which include inspirational videos, animations and interesting infographics providing further information on key lifestyle and dietary guidelines for people with diabetes, including on the role of low/no calorie sweeteners in this context. Please click here to access these materials, also available in multiple languages.

  1. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to intense sweeteners. EFSA Journal. 2011;9(6):2229. [26 pp.]. Available at: https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j. efsa.2011.2229
  2. Greyling A, Appleton KM, Raben A, Mela DJ. Acute glycemic and insulinemic effects of low- energy sweeteners: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2020;112(4):1002-1014
  3. Zhang R, Noronha JC, Khan TA, et al. The Effect of Non-Nutritive Sweetened Beverages on Postprandial Glycemic and Endocrine Responses: A Systematic Review and Network Meta- Analysis. Nutrients. 2023;15(4):1050
  4. International Diabetes Federation (IDF). IDF Diabetes Atlas, 10th edition, 2021. Available at: https://diabetesatlas.org/ (Accessed 20 August 2024)
  5. Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD). Evidence-based European recommendations for the dietary management of diabetes. Diabetologia. 2023;66(6):965-985
  6. Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019 May;42(5):731-754
  7. American Diabetes Association Professional Practice Committee. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S77-S110
  8. Laviada-Molina H, Escobar-Duque ID, Pereyra E, et al. Consenso de la Asociación Latinoamericana de Diabetes sobre uso de edulcorantes no calóricos en personas con diabetes [Consensus of the Latin-American Association of Diabetes on low calorie sweeteners in persons with diabetes]. Rev ALAD. 2018;8:152-74
  9. Diabetes UK. The use of low or no calorie sweeteners. Position Statement (Updated December 2018). Available at: https://www.diabetes.org.uk/about-us/about-the-charity/our-strategy/position-statements/use-of-low-or-no-calorie-sweetners (Accessed 20 August 2024)
  10. Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Nutrition Therapy. Can J Diabetes 2018;42(Suppl 1):S64-S79
  11. McGlynn ND, Khan TA, Wang L, et al. Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Meta-analysis. JAMA Network Open 2022;5(3):e222092
  12. Lee JJ, Khan TA, McGlynn N, et al. Relation of Change or Substitution of Low- and No-Calorie Sweetened Beverages With Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Prospective Cohort Studies. Diabetes Care 2022;45(8):1917-1930