Sweeteners and Diabetes: What’s Really True and which Options are Safe?

Sweeteners and Diabetes: an Overview

Diabetes mellitus is a chronic condition that requires continuous attention to diet, as daily dietary choices directly affect blood glucose levels and overall health. One of the most common questions asked by people with diabetes is whether they can consume sweeteners and what the safe options are.

The desire for a sweet taste remains strong, but consuming large amounts of sugar is associated with sharp increases in glucose levels, weight gain, and increased cardiometabolic risk. This is why many turn to alternatives, such as low- or zero-calorie sweeteners, which promise a sweet taste without the effects of sugar.

However, many myths and concerns circulate around sweeteners: “Are they really safe?”, “Do they affect blood sugar?”, “Can they lead to weight gain or other complications?”

In this article, based on scientific data and international guidelines, we will clarify what truly applies to sweeteners and diabetes, and which options are safe for your diet.

What are Sweeteners?

Sweeteners are substances that add sweetness to foods and beverages and are divided into two main categories: [1]

• Nutritive sweeteners (nutritive sweeteners)

They are characterized as such because they provide us with energy, i.e., calories. However, these calories are considered “empty” as they have no nutritional value.

This category includes the well-known crystalline sugar and polyols (e.g., erythritol, isomaltitol, mannitol, maltitol, sorbitol, xylitol).

• Non-nutritive sweeteners (non-nutritive sweeteners)

They are characterized as such because they contain minimal or zero calories.

Non-nutritive sweeteners exhibit greater sweetness per gram compared to nutritive sweeteners (e.g., table sugar, corn syrup, etc.), so smaller quantities are required to provide the same sweetness.

They are often referred to as “sugar substitutes” or “low-calorie sweeteners” or “artificial sweeteners” or “high-intensity sweeteners,” as they are substances with many times the sweetness of table sugar, which is the most common nutritive sweetener.

Non-nutritive sweeteners do not raise glucose levels and are therefore considered more suitable for people with diabetes.

In the European Union, 11 non-nutritive sweeteners have been approved for use. Examples of non-nutritive sweeteners include: acesulfame-K, cyclamic acid, saccharin, sucralose, steviol glycosides, neotame.

Non-nutritive Sweeteners and Potential Health Effects

Non-nutritive sweeteners (such as aspartame, sucralose, stevia, acesulfame-K, and saccharin) are evaluated as safe by international organizations such as the European Food Safety Authority (EFSA) and the U.S. Food and Drug Administration (FDA), when consumed within the Acceptable Daily Intake (ADI).

Nevertheless, the scientific community continues to study their potential long-term health effects.

• Type 2 Diabetes

Observational studies have linked increased consumption of beverages with non-nutritive sweeteners to a higher risk of developing type 2 diabetes. [2]

However, these studies do not prove a causal relationship, and potential confounding factors must be considered. For example, people who choose “diet soft drinks” often already have increased body weight or a higher cardiometabolic risk, which can affect the results.

• Cardiovascular diseases

Meta-analyses show that frequent consumption of non-nutritive sweeteners may be associated with an increased risk of cardiovascular diseases. [3]

Nevertheless, no clear mechanisms explaining the relationship have been documented, and the data primarily come from observational studies, which do not prove causality.

• Gut Microbiome

Some research suggests that sweeteners such as saccharin and sucralose may negatively affect the gut microbiome of the gut and metabolic response to glucose.[4]

However, the results are still contradictory, mainly because the data come from small studies or studies on experimental animals.

What does all this mean:

• Studies to date show correlations, not causal relationships.
• There is insufficient evidence that moderate consumption of non-nutritive sweeteners causes diabetes, cardiovascular diseases, or gut dysbiosis.
• The safest dietary goal is to reduce sweet taste in the diet, whether it comes from sugar or other sweeteners.

American Diabetes Association Recommendations for Sweeteners and Diabetes

The American Diabetes Association (ADA), through its official guidelines for diet and diabetes management, recognizes that non-nutritive sweeteners – such as aspartame, sucralose, stevia, saccharin, and acesulfame-K – can be an acceptable and safe tool for people with diabetes, provided they are consumed within the Acceptable Daily Intake (ADI) limits set by international organizations such as the European Food Safety Authority (EFSA) and the U.S. Food and Drug Administration (FDA).[5]

The ADA points out that these sweeteners do not significantly affect blood glucose and insulin levels, a fact that makes them particularly useful for individuals who need to regulate their glucose levels.

Furthermore, their use can contribute to reducing overall sugar and calorie intake, and thus to weight management, which is a critical goal in diabetes management. However, the ADA emphasizes that this benefit will only be observed provided that the calorie deficit created is not later replenished, as many end up consuming larger amounts of food, believing they “saved calories” by choosing a product with sweeteners.

The guidelines also emphasize that sweeteners should not be treated as an “alibi” for increased consumption of sweets or processed foods, but rather be integrated within the framework of a healthy and balanced diet, such as the Mediterranean diet, which has proven health benefits. The ADA’s position is clear: non-nutritive sweeteners can be a useful supportive tool, but they do not replace the fundamental importance of a healthy diet and the consumption of natural, minimally processed foods.

Finally, the ADA places particular emphasis on personalization. The use of sweeteners should be decided based on each individual’s needs, goals, and preferences, always in consultation with a dietitian or treating physician.

From this perspective, sweeteners can be a safe and practical option in the diet of people with diabetes, but without replacing the crucial role of a healthy diet and overall lifestyle in the long-term management of the disease.

Which Sweetener Options are Considered Safe?

In the European Union, 11 non-nutritive sweeteners have been approved for use in food and beverages.

All have been evaluated by the European Food Safety Authority (EFSA) and are considered safe, provided they are consumed within the Acceptable Daily Intake (ADI).

The table below summarizes the approved sweeteners and their ADI

Sweetener	E-number	Acceptable Daily Intake (mg/kg body weight/day)
Acesulfame-K	E950	9
Aspartame	E951	40
Cyclamic acid	E952	7
Saccharin	E954	5
Sucralose	E955	15
Thaumatin	E957	Not specified (no ADI limit)
Neohesperidin DC	E959	5
Steviol glycosides	E960	4
Neotame	E961	2
Aspartame-acesulfame salt	E962	As per the respective components
Advantame	E969	5

Key takeaways:

• ADI limits are not “consumption targets,” but rather maximum safe limits with a large safety margin.
• Consumption even close to ADI limits is difficult in practice for the average consumer, as very large quantities of products would be required.
• All the above sweeteners are approved and safe in the EU when used in moderation.

Common Pitfalls in Sweetener Use

Sweeteners are often promoted as the “smart solution” to reduce sugar and calories in our diet. And indeed, they can be a useful tool for people with diabetes when used correctly and in moderation.

However, experience shows that many consumers fall into certain traps. Let’s look at the most common ones:

• Overconsumption of products “light” or “sugar free“. Many believe that products with sweeteners “have no calories” and can therefore be consumed without restriction. In practice, this often leads to an increased overall calorie intake, either because we eat larger quantities or because we later “compensate” with other high-calorie foods. Thus, the benefit of choosing a soft drink or sweet with sweeteners can easily be lost.
• The illusion of the “magic solution”. Sweeteners can help reduce sugar, but they are neither a cure nor a panacea. They do not replace the importance of a balanced diet, rich in fruits, vegetables, whole grains, legumes, and healthy fats. The foundation always remains the quality and variety of the diet, not simply replacing sugar with sweeteners.
• Consumption of products with polyols. Some “sugar free” foods contain polyols, such as sorbitol, xylitol, or erythritol. Although they offer fewer calories than sugar, polyols are not fully absorbable. In large quantities, they can cause a mild increase in glucose levels, as well as undesirable gastrointestinal symptoms such as bloating or diarrhea. This is why these products often bear the label “excessive consumption may have a laxative effect.”

In conclusion, sweeteners can be safely integrated into the diet, provided they are used wisely. The secret is to view them as a tool and not a “magic solution,” and to incorporate them into a generally healthy and balanced dietary pattern.

Conclusion

Non-nutritive sweeteners are a useful tool for people with diabetes mellitus, as they offer a sweet taste without affecting blood glucose levels.

Consequently, for adults who frequently consume high-sugar foods and beverages, sweeteners can be a useful temporary strategy for reducing sugar intake. This can be particularly helpful for those accustomed to a sweet taste and for whom water, at least initially, is not a desired substitute. However, for such a substitution to be effective, it must be accompanied by an overall balanced diet plan.

However, sweeteners should not be considered an “alibi” for increased consumption of sweets or processed products, nor do they replace the importance of a healthy diet.

The most important message is that the use of sweeteners requires moderation and personalization. In collaboration with a dietitian or treating physician, each person with diabetes can choose the solutions that best suit them, always prioritizing the overall quality of their diet and general lifestyle.

References

[1] Diabetes UK. Nutritive and Non-nutritive Sweeteners. Available at: https://www.diabetes.co.uk/sweeteners/nutritive-and-nonnutritive-sweeteners.html. (Accessed September 2025).

[2] Debras C, Deschasaux-Tanguy M, Chazelas E, Sellem L, Druesne-Pecollo N, Esseddik Y, de Edelenyi F et al. Artificial Sweeteners and Risk of Type 2 Diabetes in the Prospective NutriNet-Santé Cohort. Diabetes Care. 2023, 46(9):1681-1690. doi: 10.2337/dc23-0206.

[3] Meng Υ, Li S, Khan J, Dai Z, Li C, Hu X, Shen Q, Xue Y. Sugar- and Artificially Sweetened Beverages Consumption Linked to Type 2 Diabetes, Cardiovascular Diseases, and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Nutrients. 2021, 13(8):2636. doi: 10.3390/nu13082636.

[4] Suez J, Korem T, Zeevi D, Zilberman-Schapira G, Thaiss C, Maza O, Israeli D, Zmora N et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014, 514(7521):181-6. doi: 10.1038/nature13793.

[5] ElSayed N, Aleppo G, Aroda V, Bannuru R, Brown F, Bruemmer D, Collins B et al. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care. 2023, 46(Suppl 1):S19-S40. doi: 10.2337/dc23-S002.