USE OF LOW-CALORIE SWEETENERS IN PATIENTS WITH TYPE 2 DIABETES: BENEFITS, RISKS AND SCIENTIFIC EVIDENCE

Today, one in eleven adults is diagnosed with diabetes, with approximately 90% of cases being type 2 diabetes (T2D). In recent years, the incidence and mortality rates associated with type 2 diabetes have been steadily increasing. Moreover, 280 million people have been diagnosed with impaired carbohydrate metabolism, particularly impaired glucose tolerance. This number does not include individuals who are unaware of their condition, which is estimated to be 3–4 times higher than the number of officially diagnosed cases. Type 2 diabetes is characterized by impaired carbohydrate metabolism and reduced tissue sensitivity to insulin, which necessitates blood glucose control, including limiting sugar intake. Chronic hyperglycemia leads to well-known complications, such as microvascular and macrovascular damage, as well as injury to peripheral and autonomic nerves. Maintaining normal blood glucose levels in type 2 diabetes can be achieved through well-structured nutrition. Effective disease management requires a clear understanding of which foods are contraindicated, which should be limited, and which can be consumed freely. Keeping a food diary helps monitor the diet and improve dietary control, contributing to the normalization of disturbed fat and carbohydrate metabolism. The use of sweeteners has become an important component of dietary therapy for this condition. The article analyzes various types of sweeteners differing in their origin (natural and synthetic), chemical structure, sweetness compared to sugar, as well as metabolic effects and their influence on blood glucose levels. Natural sweeteners such as stevia, erythritol, and xylitol—derived from natural sources and characterized by low or zero glycemic index—are reviewed. Synthetic sweeteners (e.g., aspartame, sucralose, acesulfame K), which have a high degree of sweetness and minimal caloric value, are also discussed. The article explores the advantages and potential risks of using different sweeteners in type 2 diabetes, including their effects on appetite, gut microbiota, body weight, and overall health. Special attention is given to their benefits, such as low caloric content and no effect on blood glucose levels, as well as to possible risks associated with long-term use. The need for an individualized approach to selecting sweeteners is emphasized, taking into account comorbidities, patient tolerance, and lifestyle factors. The aim of this article is to review the scientific literature in order to analyze and evaluate the effects of non-caloric sweeteners on glycemic control parameters in patients with type 2 diabetes.