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Objective: To examine the effect of a single high oral dose of the novel noncaloric sweetener sucralose on short-term glucose homeostasis in patients with IDDM or NIDDM., Research Design and Methods: A total of 13 IDDM and 13 NIDDM patients with glycosylated hemoglobin levels < 10% completed this double-blind cross-over study. After an overnight fast, patients were administered opaque capsules containing either 1,000 mg sucralose or cellulose placebo, followed by a standardized 360-kcal liquid breakfast. Plasma glucose and serum C-peptide levels were measured over the next 4 h., Results: Regardless of the type of diabetes, areas under the curves for changes of plasma glucose and serum C-peptide levels after sucralose administration were not significantly different from those after placebo. During test meals with sucralose, one episode of symptomatic hypoglycemia occurred in each of three IDDM patients, but these episodes were not considered the result of sucralose administration., Conclusions: The present results support the conclusion that sucralose consumption does not adversely affect short-term blood glucose control in patients with diabetes.

Combination therapy for type II (non-insulin-dependent) diabetes mellitus with insulin and sulfonylureas has been a topic of interest since the latter were introduced to clinical use. In recent years, improved understanding of potential complications associated with hyperinsulinemia has led to resurgent interest in alternatives to insulin monotherapy for patients who have failed on a regimen of diet and sulfonylureas. A plethora of clinical trials have reported on the efficacy of oral hypoglycemic agents in limiting insulin requirements while achieving glycemic control in this subset of diabetic patients. However, few studies have been appropriate in both design and duration to provide convincing results. The randomized placebo-controlled double-blind trials that have used a parallel design and study periods of up to 1 yr have uniformly investigated second-generation sulfonylureas and yielded the most reliable information. In all instances, the combination regimen achieved reduction in insulin requirement with varying evidence of a pancreatic effect as the responsible mechanism. This treatment modality is becoming more widely accepted in the effort to achieve optimal glycemic control with minimum risk to the patient.

The most important dietary precept for elderly patients with diabetes mellitus is the maintenance of desirable body weight. Weight reduction is imperative for the obese. It is now proposed that the diet prescribed contain predominantly carbohydrate (50 to 60% of total calories) and that the carbohydrates be primarily complex and rich in fiber. Protein should be of high quality, but never in excess. A diet low in saturated fats and cholesterol and proportionately higher in polyunsaturated and monounsaturated fats seems prudent in view of the accelerated incidence of macrovascular disease in this population. Lipid profiles should be carefully monitored, and carbohydrate intake may need to be limited if hypertriglyceridemia is present. Vitamin and mineral supplements may be desirable. It is important to understand that the dietary guidelines for diabetic patients discussed in this article are not fundamentally different from those for any other person desiring a healthy diet. The nutritional program outlined is a good program for everyone, and the entire family is encouraged to participate in the meal planning and preparation involved.