Non‐nutritive sweeteners for diabetes mellitus | Figure 1

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Non‐nutritive sweeteners for diabetes mellitus

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Review question

Are non‐nutritive sweeteners beneficial or harmful in people with diabetes?

Background

Non‐nutritive sweeteners are sweetening agents having higher sweetening intensity and lower calorie content per gram compared to caloric sweeteners like sucrose or corn syrups. Both the general population and diabetic people use non‐nutritive sweeteners as a caloric sweetener replacement to control their carbohydrate and energy intake. Most of the non‐nutritive sweeteners approved for human consumption are synthetic (artificial sweeteners); however, increasing numbers of natural non‐caloric sweeteners are becoming available for human consumption. Products sweetened with non‐nutritive sweeteners are widely available on the market: diet beverages, diet yoghourts, desserts, and chewing gums are the most common products containing non‐nutritive sweeteners. Non‐nutritive sweeteners are also available as table‐top sweeteners for use by consumers at home as a sweetening agent for beverages and for cooking and baking.

There is very little information about the health consequences of this intensified non‐nutritive sweeteners consumption in people with diabetes. We wanted to find out whether non‐nutritive sweeteners consumption in people with diabetes has an effect on long‐term average blood sugar levels (glycosylated haemoglobin A1c ‐ HbA1c), body weight, side effects, diabetes complications (such as heart attack, eye or kidney disease), and health‐related quality of life.

Study characteristics

We found nine randomised controlled trials (studies in which participants are assigned to one of two or more treatment groups using a random method) that allocated people with diabetes to either a group that received a non‐nutritive sweetener or a comparator group. The comparator was usual diet with additional sugar in three studies; placebo (a dummy pill) in five studies; and tagatose (a nutritive low‐calorie sweetener) in one study. The studies included a total of 979 participants; most of the studies were small, with fewer than 100 participants. The length of the studies varied from 4 to 10 months.

This evidence is up‐to‐date as of May 2019.

Key results

Data on health‐related quality of life, diabetes complications, death from any cause, and socioeconomic effects (such as absence from work, visits to general practitioner, medication consumption) were lacking, and data were generally sparse for all comparisons. The available data did not show a clear difference between non‐nutritive sweeteners and sugar, placebo, or the nutritive low‐calorie sweetener tagatose for HbA1c, body weight, and side effects.

Certainty of the evidence

We rated the overall certainty of the evidence as very low, mainly due to the small numbers of included studies and participants and methodological limitations of the included studies.

Read the full Cochrane Review here

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