Diabetes is one of the fastest growing health challenges of the 21st century
Diabetes – a dysfunction in the body’s regulation of blood-sugar levels – is one of the fastest growing health challenges of the 21st century, with the number of adults living with diabetes having more than tripled since 2000. In 2021, 537 million adults are living with diabetes – that’s 1 in 10 people and this number is expected to rise significantly by 2045 if trends continue. In Europe, 1 in 11 adults (61 million) are living with diabetes (International Diabetes Federation).
Diabetes is a serious and growing challenge to public health and places a huge burden on individuals affected and their families. People living with diabetes are at risk of developing several debilitating and life-threatening complications from cardiovascular diseases (CVD), nerve damage, kidney damage to eye disease, leading to an increased need for medical care, reduced quality of life and premature death (International Diabetes Federation).
Type 2 diabetes accounts for the vast majority (over 90%) of diabetes worldwide. The causes of type 2 diabetes are not completely understood but there is a strong link with overweight, and obesity, increasing age, ethnicity, and family history. Though, type 2 diabetes and its complications can be delayed or prevented by adopting and maintaining healthy habits, including following a balanced diet and being physically active.
A healthy diet is critical for managing diabetes
People living with type 2 diabetes can manage the disease by adopting a healthy lifestyle including enjoying a healthy diet, engaging in regular physical activity, stopping smoking and maintaining a healthy body weight. If attempts to change lifestyle are not sufficient to control blood glucose levels, oral medication would be recommended.
While there is no such thing as an exclusive diabetes diet, eating a healthy diet including a variety of vegetables, fruits, legumes, nuts, and whole grains, while being low in salt, fat and sugars is key for the prevention and management of diabetes. Carbohydrates, and in particular foods with a high-glycemic index can raise blood glucose levels quickly, which can make it harder to manage diabetes. Limiting excess intake of free sugars is globally recommended as part of a healthy diet, particularly for the prevention and management of cardiometabolic diseases such as type 2 diabetes (World Health Organization).
The supportive role of low/no calorie sweeteners for people living with diabetes
For those with diabetes, keeping blood glucose levels stable is crucial. Unlike sugars, low/no calorie sweeteners (LNCS) do not cause spikes in blood glucose levels. This makes them a safe and effective alternative for people living with diabetes to keep enjoying the sweet taste in their diet without risking a rise in glycaemia (European recommendations for the dietary management of diabetes; Diabetes UK). Decades of research, including meta-analyses of randomised control trials (RCTs – the highest quality evaluations of cause and effect) have confirmed that LNCS have no impact on glycaemic control for consumers (with or without diabetes), providing a reliable option for those needing to manage their condition (Nichol et al, 2018; Greyling et al, 2020; Zhang et al, 2023).
Managing weight without compromise
Controlling blood glucose is just one part of diabetes management. Weight management is another key factor. LNCS can help here too as replacing sugar with LNCS lowers the caloric content of foods and drinks. Because of their reduced energy content, when used instead of sugar, LNCS can support lower energy intake and in turn help with weight loss over time. The benefit depends on the level of sugar reduction achieved with LNCS substitution: the more sugar is removed from the diet, the greater the calorie reduction (Rogers et al, 2021). This dual benefit of glucose control and weight management makes LNCS a valued ally in managing diabetes.
Adhering to a healthy diet while enjoying sweetness
The advantages of LNCS aren’t limited to their health effects. The psychological aspect of diet is equally important. Although people living with diabetes have to carefully monitor what they can eat, it shouldn’t keep people from enjoying a variety of foods including some favourites in moderation. LNCS allow them to enjoy sweet-tasting foods and beverages without the associated risks of sugar, improving diet satisfaction and adherence to an overall healthy dietary pattern. There should be no expectation however that LNCS, by themselves, would decrease blood glucose levels as they are not substances that can exert pharmacologic-like effects. People with diabetes should also pay attention to other ingredients of low-calorie foods that might still affect glycaemia, e.g., other carbohydrates like starch. However, LNCS can help provide people with diabetes with wider food choices and satisfy their cravings for sweet taste without contributing to raised blood glucose levels or increased insulin needs.
As a growing health challenge impacting more and more people worldwide, diabetes must be taken seriously not only by individuals living with, or at high risk of developing diabetes but also by policymakers. In the context of World Diabetes Day, it is essential to expand and integrate tools into public health promotion strategies: tools for sugar reduction such as low/no calorie sweeteners should not be left out of public health promotion strategies.
Please tune in to our video on wellbeing and the role of nutrition for a better diabetes life in collaboration with dietitians and nutritionists from the European Specialists Dietitians Network (ESDN) for Diabetes of the European Federation of the Associations of Dietitians (EFAD). Four experts, namely Dr Maria Vasiloglou (PhD, Specialist in Nutrition and Digital Health at Nestlé Institute of Health Sciences, Switzerland, & ESDN Diabetes Committee Lead), Martina Karbanová (PhD.c. Methodology Lead in Vitadio, Czech Republic), Dr Joanna Ostrowska (PhD, Assistant Professor at the Medical University of Warsaw, Poland) and Vicky Pyrogianni (MSc, Dietitian–Nutritionist, ISA Nutrition Science Director), provide their insights on the importance of wellbeing and nutritional recommendations for the prevention and management of diabetes.