Sugar and Type 2 diabetes.

BACKGROUND: Consumption of sugar, specifically sugar-sweetened beverages, has been widely held responsible by the media for the global rise in Type 2 diabetes (T2DM). SOURCES OF DATA: Systematic reviews and dietary guidelines relating dietary sugars to T2DM. AREAS OF AGREEMENT: Weight gain and T2DM incidence are associated with diet and lifestyle patterns characterized by high consumptions of any sweetened beverages. High sugar intakes impair risk factors for macrovascular complications of T2DM. AREAS OF CONTROVERSY: Much of the association between sugars and T2DM is eliminated by adjusting data for body mass index (BMI). However, BMI adjustment does not fully account for adiposity (r2=0.65-0.75). Excess sugar can promote weight gain, thus T2DM, through extra calories, but has no unique diabetogenic effect at physiological levels. GROWING POINTS: Ethical concerns about caffeine added to sweetened beverages, undetectable by consumers, to increase consumption. AREAS TIMELY FOR DEVELOPING RESEARCH: Evidence needed for limiting dietary sugar below 10% energy intake.