Consumption Patterns and Perceptions of Non-Nutritive Sweeteners in Adults with and without Diabetes: An Analytical Comparative Study

Background: Non-nutritive sweeteners (NNS) are increasingly consumed as sugar substitutes for weight management and glycaemic control. Globally, the effectiveness and public perceptions of NNS remain debated, particularly in regions where diabetes and obesity are increasingly prevalent. Objective: To assess and compare consumption patterns and perceptions of NNS among adults with and without diabetes in Pakistan. Methods: A comparative cross-sectional study was conducted among adults (≥18 years) in health-focused environments. A total of 400 participants (200 diabetics, 200 non-diabetics) who consumed NNS were enrolled. Data were collected using a structured questionnaire on socio-demographics, NNS patterns, and the validated Perception of Artificial Sweetener Scale (PASS-23). Chi-square and t-tests were used to analyse comparisons between PASS domains and diabetes status. Results: Regular NNS consumption was more frequent among people with diabetes, mainly for glycaemic control, than non-diabetics (43.5% vs. 36.0%, p=0.007). Non-diabetics reported higher perceived benefits than people with diabetes (61.0% vs. 48.5%, p=0.012). The logistic regression model showed that participants with a high perception of benefits had 40.0% lower odds of having diabetes (OR = 0.602, p = 0.012, 95% CI: 0.405-0.896). The effect of perceiving benefits remained significant after adjusting for covariates, though slightly attenuated (aOR=0.527, 95% CI: 0.279-0.996, p=0.049). Conclusion: Diabetic participants showed greater reliance on NNS specifically for glycemic control, yet perceived fewer benefits. Given the high prevalence of regular NNS use in both groups, tailored education and consistent public messaging are needed to guide safe, effective consumption in line with the WHO's recent guidance on this additive.