Evidence does not support a relationship between diet drinks and diabetes

Posted: 21 October 2016

ISA statement in response to the study by Karolinska Institute, Sweden, on diet drinks and diabetes

The International Sweeteners Association (ISA) having reviewed this paper concludes that there is no evidence that the consumption of low calorie sweetened drinks increases the risk of developing diabetes, as a new observational study 1 by Karoliska Institute, Sweden, claims.

It is important to note that before any low calorie sweetener is approved for use in food or drinks, specific studies are required to demonstrate that low calorie sweeteners do not have any impact on either insulin secretion or blood glucose control, including in adults and children with diabetes. Therefore there is already an established and strong bank of scientific evidence that low calorie sweeteners do not affect either insulin secretion or blood glucose control. In fact, they lead to lower post-prandial blood glucose levels, a benefit for people with diabetes that has also been recognised as a health claim by the European Food Safety Authority (EFSA), “Consumption of foods containing low calorie sweeteners instead of sugar induces a lower blood glucose rise after their consumption compared to sugar-containing foods” 2.

The new study by Löfvenborg et al does not establish a causal relationship between diet drink consumption and the risk of developing diabetes. Indeed, the authors acknowledge the study’s main limitation, which is its retrospective design that may lead to recall bias. The fact that the patients were asked to recall their consumption of sweetened beverages before their diagnosis, whereas the controls were asked to recall their intake during the year directly before participation date, may introduce bias. As with all studies of observational nature, the possibility that the results are influenced by residual and unmeasured confounding factors or under-reporting cannot be excluded. As a result the higher intake of low calorie sweetened beverages may well be the consequence rather than the ‘cause’ of diabetes.

Low calorie sweeteners and foods and drinks containing them provide people with diabetes with wider food choices and the pleasure of sweet taste without contributing to raised blood glucose or insulin levels. 3 At a time when the public health burden of overweight and obesity (the major risk factor for type 2 diabetes) is so high, it would be unfortunate if people were to be discouraged from using low calorie beverages as a safe and effective means of reducing and maintaining their weight 4 due to speculative publications like this paper 1.

You can find information about the use of low calorie sweeteners for people with diabetes in the ISA factsheet ‘Sweet talk on diabetes: How can low calorie sweeteners help?’ by clicking here.

For more information on low calorie sweeteners, please visit or contact the ISA Secretariat by clicking here.


  1. Löfvenborg et al. Sweetened beverage intake and risk of latent autoimmune diabetes in adults (LADA) and type 2 diabetes. European Journal of Endocrinology (2016); 175: 605–614
  2. Commission Regulation (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health
  3. Gardner C, et al. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. (2012) Aug;35(8):1798-808
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