The aims of dietary management of diabetes mellitus are to optimize control of blood glucose levels, to minimize the risk of hypoglycaemia in those treated with insulin, to achieve weight loss in the obese and to reduce the risk of long-term complications.
In the late 1970s and early 1980s, due to accumulating evidence regarding the effects of diet on glucose and lipid metabolism in both diabetics and non diabetics, the Diabetes Associations of several countries reviewed their dietary recommendations. A recommendation common to all countries was an increased carbohydrate intake with a concomitant decrease in fat intake. In contrast, advice regarding the restriction of glucose and glucose containing disaccharides (sucrose and lactose) was unchanged. However, the rationale behind the elimination of sucrose and other simple sugars was questioned and there was a general consensus that the harmful effects of sucrose for diabetics had been exaggerated in the past1".
The dietary restriction of glucose, sucrose and lactose is based on the presumption that ingestion of glucose or a glucose-containing disaccharide results in a more rapid blood glucose response than does ingestion of the complex carbohydrate starch. Sucrose has also been implicated in the development or exaggeration of hypertriglyceridemia. However, many diabetics appear unwilling to do without sweet-tasting foods and it has been reported that the fat restriction now recommended for both diabetics and non-diabetics, becomes increasingly difficult once sucrose has been removed from the diet.
The non-nutritive sweeteners, saccharin and cyclamate, are frequently suggested alternatives to sucrose. However, to 25-33 per cent of the population, saccharin has a bitter metallic after-taste and is therefore an unsatisfactory sweetener. In addition, there is a reported link between cancer and the consumption of saccharin and cyclamate, although this area remains controversial. Cyclamate is still available for use in Australia, but it has been banned in many countries, notably the UK and the US.
The non-glucose nutritive sweeteners, fructose, xylitol and sorbitol are also marketed as being suitable for use by diabetics. However, these sucrose alternatives do not always match the sweetness quality, physical characteristics, price or digestibility of sucrose. The dipeptide, aspartame, is useful as a table-top sweetener, but has limited stability in solution, especially in non acid conditions, and it loses its sweetness at temperatures used for cooking.
Thus, although there is no specific nutritional need for sweetening agents, the availability of an acceptable sweetener may have important psychological and therapeutic implications.
