From the Guidelines
Most artificial sweeteners do not cause significant blood sugar spikes in individuals with diabetes, making them a safe alternative to sugar. According to the most recent study 1, nonnutritive sweeteners, commonly referred to as artificial sweeteners, have undergone extensive safety evaluation by regulatory agencies and are continually monitored, ensuring their safety for consumption by people with diabetes. The study suggests that for individuals with diabetes who are accustomed to regularly consuming sugar-sweetened foods or beverages, using artificial sweeteners can lead to a small improvement in body weight and cardiometabolic risk factors without evidence of harm.
Key points to consider:
- Artificial sweeteners like aspartame, saccharin, sucralose, stevia, and acesulfame potassium are considered non-nutritive and do not require insulin for metabolism 1.
- Some sugar alcohols like xylitol, sorbitol, and maltitol can have a minor impact on blood glucose, but much less than regular sugar.
- People with diabetes should still read nutrition labels carefully, as some products containing artificial sweeteners may include other ingredients that affect blood sugar.
- Individual responses can vary, so monitoring blood glucose after consuming new artificial sweeteners is recommended.
- Artificial sweeteners should be used as part of an overall healthy eating plan rather than as the sole strategy for diabetes management, as emphasized in the standards of care in diabetes-2025 1 and supported by previous guidelines 1.
From the Research
Artificial Sweeteners and Blood Sugar Levels
- Artificial sweeteners have been developed as substitutes for sugar, but their effect on blood sugar levels in individuals with diabetes is still being researched 2.
- Some studies have shown that artificial sweeteners can affect glucose absorption in the intestinal tract, as well as insulin and incretin secretion in humans and animals 2.
- Artificial sweeteners can also alter the composition of the microbiota, which can worsen glycemic control due to changes in the gut microbiota 2.
Effects of Artificial Sweeteners on Glucose and Insulin Responses
- A study compared the effects of consuming non-nutritive sweeteners (NNS) and sucrose on energy intake, blood glucose, and insulin responses, and found that NNS beverages led to higher energy intake at subsequent meals, but no difference in total daily energy intake 3.
- The study also found that sucrose-sweetened beverages led to large spikes in blood glucose and insulin responses, whereas NNS beverages had minimal influences on postprandial glucose and insulin compared to sucrose-sweetened beverages 3.
Specific Artificial Sweeteners and Their Effects
- A study evaluated the effects of four common sugar substitutes (Mogroside V, Stevioside, Sucralose, and Erythritol) on glucose, lipid, and protein metabolism in type 2 diabetic mice, and found that Mogroside V and Stevioside improved glucose and lipid metabolism, while Sucralose primarily improved lipid metabolism 4.
- The study also found that Erythritol increased lipid droplet accumulation in the liver, and that all four sugar substitutes had different effects on protein synthesis and metabolism 4.
Overall Impact of Artificial Sweeteners on Health
- A review of the role of artificial and natural sweeteners in reducing the consumption of table sugar found that commonly used non-caloric artificial sweeteners may have unfavorable effects on health, including glucose intolerance and failure to cause weight reduction 5.
- Another study found that high artificial sweetener intake was associated with all-cause mortality, cardiovascular risk, coronary artery disease risk, cerebrovascular risk, and cancer risk 2.