Diabetes & Metabolism Journal

Original Articles

Guideline/Statement/Fact Sheet
Health Effects of Sugar-Sweetened and Artificially Sweetened Beverages: Umbrella Review and Evidence-Based Consensus Statement of the Korean Diabetes Association and the Korean Nutrition Society: Jong Han Choi, SuJin Song, Soo Kyoung Kim, Jae Won Cho, Jae Hyun Bae, Shinje Moon, Jeong Hyun Lim, YeonHee Lee, Ji-Yun Hwang, YoonJu Song, Sang Soo Kim; Diabetes Metab J. 2026;50(1):32-46. Published online January 1, 2026; DOI: https://doi.org/10.4093/dmj.2025.0848

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Background
Excess intake of added sugars contributes to obesity, type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and premature mortality. Sugar-sweetened beverages (SSBs), the main source of added sugars, are consistently linked to adverse outcomes. Artificially sweetened beverages (ASBs) have been suggested as short-term substitutes, but evidence regarding benefits and harms remains inconclusive, and guidance is lacking.
Methods
This consensus statement draws on a structured evidence review combining two approaches: an updated meta-analysis of randomized controlled trials (RCTs) assessing short- to intermediate-term effects of replacing SSBs with ASBs on weight and metabolic outcomes; and an umbrella review of systematic reviews of cohort studies evaluating long-term associations of SSBs and ASBs with major outcomes, including mortality, CVD, and T2DM.
Results
In 14 RCTs (3–76 weeks), replacing SSBs with ASBs produced modest reductions in body weight (–0.73 kg) and body fat (–0.72%), with inconsistent effects on glycemic and cardiometabolic markers. Evidence from 20 systematic reviews of cohorts (up to 34 years follow-up) showed that higher intake of both SSBs and ASBs was associated with increased risks of T2DM, CVD, and mortality, with relative risks for ASBs similar to those for SSBs.
Conclusion
ASBs may serve as a short-term substitution for individuals with high SSB intake, particularly those at elevated metabolic risk. However, regular or long-term use is not recommended due to uncertain safety and potential reinforcement of sweet preference. Public health strategies should emphasize reducing both SSBs and ASBs, prioritizing water and unsweetened beverages as the ultimate goal.

Citations

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Guideline/Statement/Fact Sheet
2025 Clinical Practice Guidelines for Diabetes Management in Korea: Recommendation of the Korean Diabetes Association: Shinae Kang, Seon Mee Kang, Jong Han Choi, Seung-Hyun Ko, Bo Kyung Koo, Hyuk-Sang Kwon, Mi Kyung Kim, Sang Yong Kim, Soo-Kyung Kim, Young-eun Kim, Eun Sook Kim, Jae Hyeon Kim, Chong Hwa Kim, Ji Min Kim, Hae Jin Kim, Min Kyong Moon, Sun Joon Moon, Jun Sung Moon, Joon Ho Moon, Se Hee Min, Jung Hwan Park, Jaehyun Bae, Keeho Song, Ji Yoon Ahn, Jae-Seung Yun, Woo Je Lee, You-Bin Lee, Suk Chon, Eonju Jeon, Sang-Man Jin, Eugene Han, You-Cheol Hwang, Jae Hyun Bae, YoonJu Song, Jeong Hyun Lim, Jae Won Cho, Ji Yeon Choi, Yong Hee Hong, Jieun Lee, Sung Eun Kim, Ji Yun Noh, Bong-Soo Cha, Byung-Wan Lee; Diabetes Metab J. 2025;49(4):582-783. Published online July 1, 2025; DOI: https://doi.org/10.4093/dmj.2025.0469

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A Survey of Diabetic Educators and Patients for the Revision of Korean Food Exchange Lists: Jae Won Cho, Mee Ra Kweon, Young Mi Park, Mi Hye Woo, Hye Sook Yoo, Jeong Hyun Lim, Bo Kyung Koo, Chong Hwa Kim, Hae Jin Kim, Tae Sun Park, Choong Ho Shin, Kyu Chang Won, Soo Lim, Hak Chul Jang; Diabetes Metab J. 2011;35(2):173-181. Published online April 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.2.173

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Background

Food exchange lists are one of the main methods of nutritional education. However, Korean food exchange lists have not been revised since 1994. Therefore, we surveyed the opinions of diabetes educators and patients with diabetes regarding the need for revision of the current food exchange lists.

Methods

For two weeks beginning on 10 March 2008, a 12-item questionnaire regarding the opinion and need for revision of the current food exchange lists was e-mailed to diabetes educators nationwide. Another 15-question survey was administered to patients with diabetes in 13 hospitals located in the Seoul and Gyeonggi regions of Korea.

Results

We obtained survey responses from 101 diabetes educators and 209 patients; 65 (64.3%) of the educators answered that the current food exchange lists should be revised. The items that needed revision were the glycemic index, addition of new foods and reaffirmation of exchange standard amounts. The patients demanded specific education about choosing appropriate foods, a balanced meal plan, proper snacks, and dining intake.

Conclusion

Our survey results demonstrate the need to revise the Korean food exchange lists. This process should focus on glycemic index, the addition of new foods and reconfirmation of one exchange reference unit.

Citations

Citations to this article as recorded by

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Iva Marques-Lopes, Susana Menal-Puey, J. Alfredo Martínez, Giuseppe Russolillo
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Korean Food Exchange Lists for Diabetes: Revised 2010
Dal Lae Ju, Hak Chul Jang, Young Yun Cho, Jae Won Cho, Hye Sook Yoo, Kyung Suk Choi, Mi Hye Woo, Cheong Min Sohn, Yoo Kyoung Park, Ryowon Choue
The Korean Journal of Nutrition.2011; 44(6): 577. CrossRef

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