The need for special dietary products marketed for use by individuals with
diabetes mellitus and the safety and efficacy of certain nutritive
sweetener substitutes for
sucrose are reviewed. Special foods for individuals with
diabetes mellitus are not necessary to achieve the dietary objectives recommended by leading United States and European authorities. They can be achieved conveniently and at minimum expense through enlightened choices of commonly available food items. At present, specific and unique characteristics of food products with special therapeutic properties for diets of diabetic individuals cannot be delineated or defined on rational nutritional grounds. Such terms as "diet", "dietetic", and "diabetic" on food labels have no uniform meaning for consumers, and diabetologists have observed that patients tend to consume such foods without regard to their energy content. Some consumers regard the reduced-calorie and low-calorie prepared food products as convenient in diets for
weight reduction and diabetes although their use in dietary management of diabetes has no therapeutic basis other than
weight reduction and maintenance. When fed as pure substances to fasted subjects, the nonglucose
carbohydrate nutritive sweeteners,
fructose,
xylitol, and
sorbitol, are absorbed relatively slowly and produce less
postprandial hyperglycemia and
insulin response than
sucrose or
glucose. Adequate studies of their long-term effectiveness when ingested as part of mixed meals have not been conducted. Although these
sucrose substitutes are generally considered safe, the significance of recent information on possible carcinogenicity of oral
xylitol in long-term feeding studies has not been fully evaluated. In view of the lack of certain essential information on the long-term effectiveness of various diets in preventing or mitigating the chronic debilitating complication of diabetes, suggestions for future research are included.