(P13-25-26) Acute Glucose, Hormonal, and Appetite Responses to Breakfasts Following Non-nutritive Sweetener Pre-loads in Participants With Type 2 Diabetes

Objectives: Non-nutritive sweeteners (NNS) are used as sugar substitutes for individuals with type 2 diabetes (T2D); their acute effects on postprandial hormones and subsequent food intake remain unclear. This study compared the acute effect of a preload of sucralose or stevia before consuming a carbohydrate-containing breakfast on postprandial glucose, insulin, and satiety hormones, appetite sensations, and subsequent food intake in adults with T2D.

Methods: A randomized, single-blind, crossover trial, comparing acute responses to preloads of water (control), 48 mg sucralose, or 96 mg stevia 10 min before consumption of an isocarbohydrate breakfast (71.9 g available carbohydrate). Plasma glucose, insulin, ghrelin, and GLP-1 were measured over 180 min and areas under the curve (AUC) were calculated. Appetite sensations were assessed using visual analog scales. Energy intake was evaluated during a standardized ad libitum buffet meal. Repeated-measures ANOVA or non-parametric equivalents were used. Data are presented as means ± standard deviations or medians (interquartile range). Mean differences between treatments (MD) and 95% confidence intervals (95% CI) were calculated.

Results: Seventeen adults with T2D (age 45.5 ± 7.6 years; BMI 30.9 ± 3.7 kg/m²; HbA1c 6.5 ± 0.8%) completed the study. Compared with water, the sucralose preload increased blood GLP-1 (AUC MD, 0.41 (95% CI: 0.08–0.74), P < 0.017), and the stevia preload tended to increase blood GLP-1 (MD, 0.32 (95% CI: -0.02–0.65; P = 0.062), without any significant effects on glycemia, insulinemia, or ghrelinemia. At 60 min post-breakfast, hunger ratings were higher after sucralose and stevia compared with water (both p < 0.05). At 120 min, desire to eat was greater after stevia than water (p = 0.041). Energy intake during the buffet was higher only after stevia (592 ± 230 kcal) compared with water (485 ± 214 kcal), driven by greater protein and fat consumption (p = 0.028).

Conclusions: Our study demonstrated that in adults with T2D, sucralose versus water differentially enhanced GLP-1 concentrations in response to a breakfast meal, while glycemic effects were neutral. While sucralose and stevia stimulated hunger post-meal, only stevia promoted more energy intake. Acute preloads of stevia may impair appetite regulation in people with T2D.

Funding Sources: Chilean Society of Nutrition (SOCHINUT)