Added Sugar and Diabetes: Are We Counting It All?

Why might dietary surveys underestimate added sugar?

The ICMR–INDIAB dietary analysis counted sugar added during cooking, at the table and in packaged products that declared added sugars. Its authors acknowledged that this approach could miss contributions from foods sold without such information, including bakery products and traditional sweets. Actual intake could therefore exceed the estimates. [Nature Medicine study](https://www.nature.com/articles/s41591-025-03949-4).

The study was cross-sectional: it examined dietary reports alongside metabolic measurements rather than assigning diets and tracking subsequent disease. It cannot establish cause and effect, and dietary reporting errors or other differences between participants may influence the associations. Newly detected diabetes means identified during assessment, not necessarily newly developed disease.

Do honey, fruit juice and table sugar count toward the same limit?

Added sugars and free sugars overlap, but the terms are not interchangeable. WHO's broader free-sugar category includes sugars added by manufacturers, cooks or consumers, plus those in honey, syrups and fruit juice. Consequently, a juice labelled 'no added sugar' can still contribute free sugars. Sugars contained within whole fruit are treated differently. [WHO information note](https://tdr.who.int/publications/i/item/WHO-NMH-NHD-15.3).

WHO recommends keeping free sugars below 10% of daily energy and conditionally suggests reducing them below 5% for additional benefits. For a 2,000-calorie diet, these thresholds correspond to less than 50 grams and less than 25 grams, respectively. These are population nutrition targets, not a boundary below which diabetes becomes impossible. The guidance principally addresses unhealthy weight gain and tooth decay; it does not assign an individual diabetes probability to each spoonful consumed. [WHO sugar recommendations](https://www.who.int/tools/elena/interventions/free-sugars-adults-ncds).

How can people reduce sugar without overlooking other diabetes risks?

A practical starting point is to examine frequently consumed drinks and snacks: sweetened tea or coffee, soft drinks, juice and confectionery can contribute sugar across the day. Choosing water or unsweetened drinks and whole fruit instead of juice can reduce these sources. Packaged-food information helps when available, but home recipes and foods purchased without labels also deserve attention. WHO recommends a varied diet built around vegetables, fruit, pulses and whole grains. [WHO healthy-diet guidance](https://www.who.int/news-room/fact-sheets/detail/healthy-diet).

Diabetes prevention extends beyond sugar counting. Insulin resistance develops when the body's cells respond inadequately to insulin, and blood glucose can rise when the pancreas cannot compensate. Family history, physical inactivity, excess abdominal fat and previous gestational diabetes are among relevant risk factors. Prediabetes often causes no symptoms, so people with risk factors should discuss blood testing with a healthcare professional rather than judging their metabolic health from their sweet-food intake alone. [NIDDK guidance on insulin resistance and prediabetes](https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance).