Supplements · Sweeteners

non-nutritive sweeteners increases diabetes risk

In plain terms: Do artificial sweeteners raise your risk of type 2 diabetes?

Leans support Supplements

RefutedContestedStrong support

consensus score 0.39

People who drink artificially sweetened drinks do get type 2 diabetes somewhat more often, but much of that link may be because people already at risk switch to diet drinks. No trial has tested whether sweeteners cause diabetes.

📅 Last reviewed: 2026-07-15 ⓘ

Evidence ladder

How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."

Top evidence so far: All trials, pooled (Meta-analysis)

MechanismIn-vitroAnimalObservationalRCTMeta-analysis

How the studies fall

4 support 0 contradict 0 tested null 4 mixed · 8 sources, 4 independent groups

What the evidence shows

Artificially-sweetened-beverage consumption is consistently associated with higher type-2-diabetes incidence across large cohorts and dose-response meta-analyses (RR 1.13 per daily serving, 95% CI 1.03–1.25; NutriNet-Santé also finds a link) — so as an association the claim leans supported.

Cochrane has no ruling yet see how our grade compares ▾

Cochrane review 2020 · very low certainty Not directly comparable

Population is people who ALREADY have type 1 or 2 diabetes, not incident-diabetes risk in the general population.

“Non-nutritive sweeteners for diabetes mellitus (CD012885.pub2). 'There is inconclusive evidence of very low certainty regarding the effects of NNS consumption compared with either sugar, placebo, or nutritive low-calorie sweetener consumption on clinically relevant benefit or harm for HbA1c, body weight, and adverse events in people with type 1 or type 2 diabetes.'”

Not directly comparable: their review asks a different question or reports an outcome we do not grade, so it neither corroborates nor contradicts this claim.

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The evidence (9)

Source	Grade	Stance	Quality	Finding
Drouin-Chartier JP, Zheng Y, Li Y, Malik V, Pan A, Bhupathiraju SN, Tobias DK, Manson JE, Willett WC, Hu FB 2019 · Diabetes Care	observational	supports	moderate	Three large US cohorts: increases in ASB consumption associated with modestly higher subsequent T2D risk (attenuated by BMI).
Payen de la Garanderie M, Hasenbohler A, Dechamp N, Javaux G, Szabo de Edelenyi F, Agaësse C, De Sa A, Bourhis L, Porcher R, Pierre F, Coumoul X, Kesse-Guyot E, Allès B, Fezeu LK, Cosson E, Tatulashvili S, Huybrechts I, Hercberg S, Deschasaux-Tanguy M, Chassaing B, Rytter H, Srour B, Touvier M 2025 · PLoS Med	observational	mixed	moderate	NutriNet-Santé food-additive mixtures (incl. a sweetener/emulsifier cluster) associated with higher T2D incidence.
Qin P, Li Q, Zhao Y, Chen Q, Sun X, Liu Y, Li H, Wang T, Chen X, Zhou Q, Guo C, Zhang D, Tian G, Liu D, Qie R, Han M, Huang S, Wu X, Li Y, Feng Y, Yang X, Hu F, Hu D, Zhang M 2020 · Eur J Epidemiol	meta-analysis	supports	moderate	Dose-response MA: ASB associated with higher T2D (and obesity, hypertension).
Meng Y, Li S, Khan J, Dai Z, Li C, Hu X, Shen Q, Xue Y 2021 · Nutrients	meta-analysis	supports	low	Dose-response MA of prospective cohorts: 'the pooled RR for T2D for each additional ASB serving per day was 1.13 (95%CI: 1.03–1.25)' (7 studies, I2 = 78.7%, non-linear); highest-vs-lowest 'ASBs intake contributed to an 18% higher risk of T2D in these cohorts (RR: 1.18; 95% CI: 1.08–1.29)'. Quality low: publication bias not assessable (<10 groups), no adiposity or reverse-causation handling, and the authors conclude that for ASBs 'the quality of the evidence is limited by potential bias and heterogeneity due to the design of the study'.
Debras C, Deschasaux-Tanguy M, Chazelas E, Sellem L, Druesne-Pecollo N, Esseddik Y, Szabo de Edelenyi F, Agaësse C, De Sa A, Lutchia R, Julia C, Kesse-Guyot E, Allès B, Galan P, Hercberg S, Huybrechts I, Cosson E, Tatulashvili S, Srour B, Touvier M 2023 · Diabetes Care	observational	supports	high	NutriNet-Santé: total artificial sweeteners (esp. aspartame, acesulfame-K) associated with higher type-2-diabetes risk.
Greenwood DC, Threapleton DE, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, Burley VJ 2014 · Br J Nutr	meta-analysis	mixed	moderate	MA: ASB–T2D association less consistent than SSB and attenuated by BMI adjustment — possible confounding/reverse causation.
Imamura F, O'Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, Forouhi NG 2015 · BMJ 2015;351:h3576	meta-analysis	mixed	high	Same BMJ meta-analysis, artificially sweetened beverages in 10 of the 17 cohorts. Per one serving/day: RR 1.25 (1.18 to 1.33) before and 1.08 (1.02 to 1.15) after adjustment for adiposity - 'After adjustment, the estimate of 25% greater incidence was attenuated to 8% (2.1% to 15%)' - so a positive association remains on the face of it, and information-bias calibration strengthens it to 1.29 (1.08 to 1.54). But the paper's own bias analyses dissolve it: 'Trim and fill indicated publication bias for both sugar sweetened and artificially sweetened beverages', after which the ASB estimate is 1.22 (0.98 to 1.52), P=0.07; and in the residual-confounding simulation the ASB association 'was attenuated by 96% (1.01, 0.81 to 1.25)' against only 26% for SSB. Hence the authors' verdict: 'We rated the evidence for artificially sweetened beverages and fruit juice to be of low quality' because 'Findings for artificially sweetened beverages were likely to have publication bias and residual confounding'. The operative explanation the paper gives is confounding by adiposity and health status - 'adults at high risk of type 2 diabetes preferentially consumed more artificially sweetened beverages' - with reverse causality named only as a possible additional limitation, not as a finding. Exposure is diet SOFT DRINKS, not sweeteners as such: 'No study assessed subtypes'. A positive point estimate the paper itself argues is bias: no net sign.
Ayoub-Charette S, Kavanagh M, Khan T, Sievenpiper J 2025 · Appl Physiol Nutr Metab	meta-analysis	contradicts	high	Umbrella review, units are syntheses: 'We included six trial- and five cohort-based analyses.' Naive cohort analyses linked LNCS to higher diabetes; bias-adjusted analyses to lower obesity. Review — zero weight.
Lohner S, Kuellenberg de Gaudry D, Toews I, Ferenci T, Meerpohl JJ 2020 · Cochrane Database Syst Rev	meta-analysis	mixed	moderate	Cochrane (NNS in diabetes): insufficient evidence to establish benefit or harm on hard outcomes.

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