Knowledge, awareness, and usage patterns of artificial sweeteners (as) amongst people with diabetes: A cross-sectional study

Knowledge, awareness, and usage patterns of artificial sweeteners (as) amongst people with diabetes: A cross-sectional study - Background: The rising prevalence of Non-Communicable Diseases (NCDs) in India, particularly type 2 diabetes mellitus (T2D), poses a significant public health challenge. Effective dietary strategies, including carbohydrate counting and artificial sweeteners (AS), can aid in glycaemic control. AS offers caloric reduction and dietary flexibility, yet their awareness and usage remain understudied. This study aims to assess the knowledge, perception, and adoption of AS among individuals with T2D in India. Materials and Methods: This cross-sectional study was conducted among individuals in India from June 2024 to November 2024. Data collection was carried out through an online survey link shared via social media and personal networks. Participants self-screened by confirming a prior T2D diagnosis by a physician. The survey outlined eligibility criteria and duration upfront. No personal identifiers such as email ID, mobile number, address, name or IP address were collected to ensure anonymity and confidentiality. Results: 1,710 individuals with type 2 diabetes (T2D) across India participated, with 53% female and 47% male. The majority (55%) were aged 51–70 years, with an average diabetes duration of 9.2 years (SD 7.5 years). 22% were on insulin, and 42% had comorbidities, mainly hypertension, thyroid disorders, and high cholesterol. 58% were aware of AS, with higher awareness in those aged 35 years (56.3%, p Despite awareness, only 18.4% regularly used AS, and 13% used them occasionally. Awareness of long-term side effects was low (24%), and even lower among AS users (19%, p=0.039). 10% of users reported digestive issues like bloating or constipation. 96% reported no weight changes, while 91% experienced reduced sugar cravings. Interest in learning about AS was higher among aware individuals (48%) than the unaware group (27%, p Conclusion: Our study highlights low awareness of artificial sweetener (AS) side effects. Promoting nutrition label reading, judicious AS use, and nutritional education can aid informed choices. Future research should explore AS effects on micro biota, glucose homeostasis, body weight, and cardiovascular health in type 2 diabetes. Additionally, there is limited interest in learning about AS. Large-scale awareness campaigns are essential to educate individuals on potential long-term risks and support informed decision-making. Keywords: Type 2 diabetes mellitus, Diabetes complications, Knowledge, Awareness, Artificial Sweeteners