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Sugar and type 2 diabetes

07 / 02 / 17

This invited review was completed jointly between two authors; Michael Lean from Glasgow Royal Infirmary and Lisa Te Morenga from Otago University. Their brief was to investigate whether sugar, and specifically sugar sweetened beverages (SSB) are responsible for the global rise of type 2 diabetes (T2DM) by reviewing systematic reviews and dietary guidelines. They found areas of agreement and areas of controversy.

The agreed areas were that weight gain and T2DM are associated with diet and lifestyle patterns characterised by high SSB consumption. The controversies were around the fact that much of the association between SSB and T2DM is eliminated by adjusting for BMI. Excess sugar can promote weight gain but has no diabetogenic effect at physiological levels. Sugar is not hazardous for people with diabetes, and the evidence supports a limit of 10% energy from free sugars to reduce macrovascular complications.

They conclude that the evidence linking sugar directly to T2DM is unconvincing, but excess consumption of sweetened food and drinks have a small but important role in promoting weight gain, itself a risk factor for T2DM. They add that the current media fixation on sugar has led to the perception that it is the most important contributor to increasing rates of T2DM when overweight and obesity are the dominant cause. Becoming overly focused on reducing sugar intakes to possibly unrealistic levels risks overlooking or undermining other strategies based on proven dietary and lifestyle approaches for T2DM prevention.

Lean ME, Te Morenga L. Sugar and type 2 diabetes. Br Med Bull 2016; 119:1-11 http://bmb.oxfordjournals.org/content/early/2016/10/05/bmb.ldw037.abstract