Abstract
Objective: To evaluate the impact of nonnutritive sugar substitutes on glycemic control in patients with diabetes. Data Sources: A comprehensive review of the literature was conducted in PubMed (1966-March 2012) and Scopus. A combination of MeSH terms and keywords were used, including acesulfame, aspartame, diabetes, neotame, rebiana, saccharin, stevia, and sucralose. Study Selection and Data Extraction: Clinical studies evaluating the impact of nonnutritive sweeteners on measures of diabetic control, including, but not limited to, blood glucose levels, postprandial blood glucose, and hemoglobin A1c were selected for review. Searches were limited to only nonnutritive sweeteners available in the US. Data Synthesis: Nine clinical trials that evaluated nonnutritive sweeteners in a total of 490 patients with diabetes were found. Doses of sweeteners in the studies varied from below acceptable daily intake levels for 3 consecutive days to daily dosing for up to 18 weeks and up to 3.5 times the acceptable daily intake levels. No significant differences in overall effects on glycemic control and insulin response were found. Conclusions: Nonnutritive sweeteners do not appear to affect glycemic control in patients with diabetes. Patients should be counseled to maintain an appropriate energy balance in their diet, with or without the use of nonnutritive sweeteners.
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