Do Sugar Substitutes Have Any Impact on Glycemic Control in Patients with Diabetes?

Behnen, Erin M.; Ferguson, McKenzie C; Carlson, Amy

doi:10.1177/875512251302900203

Cited by 10 publications

(8 citation statements)

References 18 publications

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“…38,39 For example, patients with type 2 diabetes who took stevia for 3 months had no increase in their blood sugar levels. 40 In another study, patients who were supplemented with sucralose for 4 weeks also found no increase in blood sugar compared to the control group. 41 This may be due to the large difference in sweetness between different sweeteners at similar concentrations, as well as the great difference in sweetness intensity and durability.…”

Section: Discussionmentioning

confidence: 92%

“…But, it has been reported that stevia can increase insulin sensitivity in diabetic rats and induce anti‐hyperglycemia effect . For example, patients with type 2 diabetes who took stevia for 3 months had no increase in their blood sugar levels . In another study, patients who were supplemented with sucralose for 4 weeks also found no increase in blood sugar compared to the control group .…”

Section: Discussionmentioning

confidence: 97%

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Low intake of digestible carbohydrates ameliorates duodenal absorption of carbohydrates in mice with glucose metabolism disorders induced by artificial sweeteners

et al. 2019

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Background Long‐term artificial sweetener consumption has been reported to induce glucose intolerance, and the intestinal microbiota seems as an important target. While the impacts of artificial sweeteners on energy balance remain controversial, this work aimed to evaluate the protective effects in mice of a low digestible carbohydrate (LDC) diet on plasma glucose, plasma fasting insulin, sweet taste receptors, glucose transporters, and absorption of carbohydrates, together with consumption of acesulfame potassium (AK) or saccharin (SAC). Results Artificial sweetener was administered to mice for 12 weeks to induce glucose metabolism disorders; mice were treated with an LDC diet for the final 6 weeks. The experimental groups were treated with an LDC diet that had the same energy as the normal‐diet group. Prolonged administration of artificial sweeteners led to metabolic dysfunction, characterized by significantly increased plasma glucose, insulin resistance, sweet taste receptors, glucose transporters, and absorption of carbohydrates. Treatment with an LDC diet positively modulated these altered parameters, suggesting overall beneficial effects of an LDC diet on detrimental changes associated with artificial sweeteners. Conclusions Reducing digestible carbohydrates in the diet can significantly reduce the absorption of carbohydrates and improve glucose metabolism disorders caused by dietary factors. These effects may be due to the fact that reducing the amount of digestible carbohydrates in the feed can reduce the number of intestinal sweet receptors induced by exposure to artificial sweeteners. © 2019 Society of Chemical Industry

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Low intake of digestible carbohydrates ameliorates duodenal absorption of carbohydrates in mice with glucose metabolism disorders induced by artificial sweeteners

et al. 2019

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“…However, while LES stimulation of such systems has mainly been demonstrated in vitro and with animal models, it is uncertain whether these effects are physiologically relevant in humans (13,14). Furthermore, a substantial body of human intervention data suggests that overall, LES intake has no significant acute or chronic effects on measures of glucose homeostasis (10,(15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials

Greyling

Appleton

Raben

et al. 2020

The American Journal of Clinical Nutrition

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Background It has been suggested that low-energy sweeteners (LES) may be associated with an increased risk of metabolic diseases, possibly due to stimulation of glucose-responsive mechanisms. Objective We conducted a systematic review and meta-analysis of human intervention studies examining the acute effect of LES intake on postprandial glucose (PPG) and postprandial insulin (PPI) responses, in order to comprehensively and objectively quantify these relations. Methods We systematically searched the Medline, OVID FSTA, and SCOPUS databases until January 2020. Randomized controlled trials comparing acute postprandial effects on PPG and/or PPI after exposure to LES, either alone, with a meal, or with other nutrient-containing preloads to the same intervention without LES were eligible for inclusion. PPG and PPI responses were calculated as mean incremental area under the curve divided by time. Meta-analyses were performed using random effects models with inverse variance weighing. Results Twenty-six papers (34 PPG trials and 29 PPI trials) were included. There were no reports of statistically significant differences in the effects of LES on PPG and PPI responses compared with control interventions. Pooled effects of LES intake on the mean change difference in PPG and PPI were −0.02 mmol/L (95% CI: −0.09, 0.05) and −2.39 pmol/L (95% CI: −11.83, 7.05), respectively. The results did not appreciably differ by the type or dose of LES consumed, cointervention type, or fasting glucose and insulin levels. Among patients with type 2 diabetes, the mean change difference indicated a smaller PPG response after exposure to LES compared with the control (−0.3 mmol/L; 95% CI: −0.53, −0.07). Conclusions Ingestion of LES, administered alone or in combination with a nutrient-containing preload, has no acute effects on the mean change in postprandial glycemic or insulinemic responses compared with a control intervention. Apart from a small beneficial effect on PPG (−0.3 mmol/L) in studies enrolling patients with type 2 diabetes, the effects did not differ by type or dose of LES, or fasting glucose or insulin levels. This review and meta-analysis was registered at PROSPERO as CRD42018099608.

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“…LES may be disproportionately used in place of sugar by individuals with a pre-existing history or elevated risk of weight gain or diabetes, and this caveat is often highlighted in the original papers (e.g., 69). Moreover, in the case of LES, the likelihood that epidemiological associations are specious is reinforced where the corresponding RCT data for related outcomes consistently indicate neutral or beneficial effects (8,41). As a result, several authors have expressed doubt about the weight that should be placed on observational (and animal) studies in this area for outcomes where data from sustained RCTs are available (8,13,70,71).…”

Section: Acknowledge the Limitations Of Observational And Animal Datamentioning

confidence: 99%

Perspective: Standards for Research and Reporting on Low-Energy (“Artificial”) Sweeteners

Mela¹,

McLaughlin²,

Rogers³

2020

Advances in Nutrition

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Widely differing views exist among experts, policy makers, and the general public with regard to the potential risks and benefits of reduced- or low-energy sweeteners (LES) in the diet. These views are informed and influenced by different types of research in LES, with differing hypotheses, designs, interpretation, and communication. Given the high level of interest in LES, and the public health relevance of the research evidence base, it is important that all aspects of the research process are framed and reported in an appropriate and balanced manner. In this Perspective, we identify and give examples of a number of issues relating to research and reviews on LES, which may contribute toward apparent inconsistencies in the content and understanding of the totality of evidence. We conclude with a set of recommendations for authors, reviewers and journal editors, as general guidance to improve and better standardize the quality of LES research design, interpretation, and reporting. These focus on clarity of underlying hypotheses, characterization of exposures, and the placement and weighting of new research within the wider context of related prior work.

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Do Sugar Substitutes Have Any Impact on Glycemic Control in Patients with Diabetes?

Cited by 10 publications

References 18 publications

Low intake of digestible carbohydrates ameliorates duodenal absorption of carbohydrates in mice with glucose metabolism disorders induced by artificial sweeteners

Low intake of digestible carbohydrates ameliorates duodenal absorption of carbohydrates in mice with glucose metabolism disorders induced by artificial sweeteners

Acute glycemic and insulinemic effects of low-energy sweeteners: a systematic review and meta-analysis of randomized controlled trials

Perspective: Standards for Research and Reporting on Low-Energy (“Artificial”) Sweeteners

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