A presentation by Dr Hugo Laviada Molina at the ISA Conference 2018
When only observational data are considered, several cohort studies have shown an association between type 2 diabetes (DM2) and the use of low calorie sweeteners (LCS). However, when controlled clinical trials are assessed, the vast majority of them show that LCS have a neutral effect on outcomes such as glycosylated haemoglobin (HbA1C), blood insulin, and fasting or postprandial glucose levels. Moreover, in trials where LCSs are integrated within a structured nutritional plan as a replacement for sucrose, discrete benefits can be seen on these clinical parameters. It would seem that, considered separately, observational and interventional studies report contradictory conclusions regarding LCS on metabolic impact. The positive association between LCS use and risk of DM2 found in some cohort studies seems to be mediated, at least in part, by confounding factors, in particular adiposity, and the so-called “reverse causality” effect. Recent reviews have assessed the published controlled trials, which represent the highest level of evidence, examining the effect of LCS on the metabolism of carbohydrates. In a review conducted by Romo-Romo et al in 2016, the heterogeneity of the studies did not allowed to conduct a meta-analysis. Using Romo-Romo et al data and the studies published thereafter, we identified 30 intervention trials. All trials assessed the effect on blood glucose: 22 studies (73,3%) did not find significant changes, 5 studies (16.7%) reported a slight decrease with LCS use, and 3 studies (10%) a slight increase. In the studies reporting improvements in metabolic parameters, evidence suggests that this is due to the substitution of sugars, rather than to an intrinsic effect of LCS. Per se these additives do not seem to have an effect on carbohydrate metabolism and on blood glucose levels.